11519 2ND AVE SE 2024-02-28 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EV E R E T T SUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitSetvicesQeverettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everetNm.gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2 Z L 1/r'�� U&I Q5ao` SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL. ❑INDUSTRIAL IF APPLICABLE: ❑LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IFAPPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME$JOB M JOB#: DESCRIPTION OF SITE WORK I RIGHT--OF-WAY WORK: ' FILL W ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer ❑ASPHALT/CONCRETE PAVING SF 0 Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑ CLEARING/GRADING i FILL I EXCAVATE CY ❑MR2 Only 0 MRI-5 0 MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Root Area: SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): ITotal New+Replaced: SF a d motif 7o i ��141-L 41- . PIP 0- 0d P'44 t V- 'd e- dlk� n t4 Le veL, - e carrot ,gO - e¢ ON cll ud s ,'rVN1 W 1n y P fV t;r '4g" -Ilie- ddcA 1,5, ) ,'Ideep, 1- 4t 6e- Piaed C« I6d Ads - o Vej- lie i p< -/v SwAce L.evqL CONTACT'INFORMATION OWNER 1 APPLICANT NAME: @V iAl OWNER/APP. MAILING ADDRESS: STREETI(5-/? UQi �& ^� p Z v�/ re CITY STATE Wet-- ZW pa©O OWNER i APP.PHONE:T "7Rt"Orj/* OWNER I APP.EMAIL: M�41r t tl 076R awl.' Coln `Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: A/JA STREET CITY STATE ZIP CONTRACTOR PHONE: /� CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: AOWNER I APPLICANT ❑CONTRACTOR ❑OTHER(Architect,Engineer,Etc.) CONTACT NAME: CONTACT PHONE: IqA 157-- k-'eViN C—rnpt ICONTACT EMAIL: ACKNOWLEDGEMENT.-i have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local lava The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the Building Official before being authorized under any circumstance.I am the owner,or t am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only [PERMIT [PW Owner/Authorized Agent Signature Date (Revised 4/21/2022)