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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https:Heverettwa.gov/permits <br />' . - <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 1005 North Park Drive, Everett WA, 98203 <br />SITE WORK FOR PROJECT TYPE: ©SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY []COMMERCIAL ❑INDUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S NAME & JOB #: JOB # <br />DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />© FENCE IN ROW 6 Foot wood fence FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT FT WIDE <br />❑ ASPHALT / CONCRETE PAVING SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF <br />❑ POLE WORK / AERIAL / OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDED): <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />❑ Combined Sewer <br />❑ Separated Storm Sewer <br />❑ Direct Discharge to Snohomish River or Puget Sound <br />TRIGGERED REQUIREMENTS: <br />❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Roof Area SF <br />Proposed Hardscape: SF <br />Total New+ Replaced: SF <br />Request permit for a 6 foot woo fence to be built in public riqht away alonq NE portion of N Park Dr.) The <br />fence would be 59 feet lonq and start 30 feet from the corner of Crown Dr and N Park Dr. It would be <br />3 feet from the existinq curb. Existinq fence to be removed. See attached site plan. <br />CONTACT INFORMATION <br />OWNER / APPLICANT NAME: Alan KObuke <br />OWNER / APP. MAILING ADDRESS: STREET 1005 North Park Drive <br />CITY Everett STATE W" A ' Z,P 98203 <br />OWNER / APP. PHONE: 206-369-4601 <br />OWNER / APP. EMAIL: akobuke@frontier.com <br />*Required for Work in Public Right -of -Way <br />CONTRACTOR NAME: Owner <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ✓❑ OWNER I APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: <br />Alan Kobuke <br />CONTACT PHONE: 206-369-4601 <br />CONTACT EMAIL:akobuke@frontier.com <br />ACKNOWLEDGEMENT. 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br />comply with current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be <br />authorized in writing from the Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to <br />perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG <br />City of Everett Official Use Only <br />PERMIT # <br />PW <br />caner/Authorized Agent Signature Date (Revised 1172019) <br />