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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://everettwa.gov/permits <br />P1tOJECT' SITE INFORMAT10N <br />(PROJECT ADDRESS: 1 005 North Park Drive, Everett WA, 98203 1 <br />SITE WORK FOR PROJECT TYPE: QSFR-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 />QE i.CRIPTION OF SITE WORK /RIGHT-OF=WAY VI�ORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWA TER DISCHARGES TO: <br />❑✓ FENCE IN ROW 6 Foot wood fence FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT FT WIDE <br />❑ Combined Sewer <br />❑ ASPHALT / CONCRETE PAVING SF <br />❑ Separated Storm Sewer <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />❑ Direct Discharge to Snohomish River or Puget Sound <br />TRIGGERED REQUIREMENTS: <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE CY <br />❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF <br />Proposed Roof Area: SF <br />❑ POLE WORK / AERIAL / OVERLASH LF <br />Proposed Hardscape: SF <br />ADDITIONAL DESCRIPTION (AS NEEDED): <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 existing curb. Existinq fence to be removed. See attached site plan. <br />CONTACT INFORMATION <br />F / APPLICANT NAME: Alan Kobuke <br />OWNER / APP. MAILING ADDRESS: STREET 1005 North Park Drive <br />CITY Eve rett STATE WA " ' ZIP 98203 <br />OWNER / APP. PHONE: 206-369-4601 <br />1OWNER / 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 / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: Alan Kobuke <br />CONTACT PHONE: 206-369-4601 <br />CONTACT EMAIL:akobuke@frontier.com <br />ACKNOWLEDGEMENT: I 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. l am the owner, or I am authorized by the owner of this property to <br />perform the work for which application is made, and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />PW <br />caner/Authorized Agent Signature Date (Revised 1172019) <br />