2215 COLUMBIA AVE 2024-03-27 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES . EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: �ZI C ��lt-rr+ IO. 1/a— SITE WORK FOR PROJECT TYPE: SFR-DETACHED []TOWNHOUSE []DUPLEX OADU ❑MULTI-FAMILY []COMMERCIAL OINDUSTRIAL IF APPLICABLE: ❑LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) IV114 IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# A114 UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SI WORK I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO.- DRIVEWAY O:DRIVEWAY APRON/CURB CUT FT WIDE ❑Combined Sewer g ASPHALT I CONCRETE PAVING g 2 SF ❑Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound O RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING I FILL I EXCAVATE CY ❑MR2 Only O MRI-5 ❑MRI-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION AS NEEDED): Total New+Replaced: SF .9-mUd Z ''d e e ,/ OaJ to 5 e, 1,J ""4- ISL P ovt Ta,-,r ?Nree,I r"D. W 0cJ5��150� '7 U L 0o Zv-"e- -2 CONTACT INFORMATION OWNER/APPLICANT NAME: OWNER/APP. MAILING ADDRESS: STREET Z 2 /,'j' CC /L.tX" b CZ. JQVe, 11CITY Ve YQ r Lt)/4 STATE ZIP �gZO3 OWNER/APP.PHONE: &L!JJ 5-13-F-507 OWNER/APP.EMAIL: Ce,m 'Required for Work in Public Right-of-Way U CONTRACTOR NAME: D 4 uta+ Fa v►v" CONTRACTOR ADDRESS: ... J l 702--7-r h Ave . SE �1 CRY E've,Y e-t 1 STATE W A ZIP 179 Zv(:l CONTRACTOR PHONE: Z O 63 Y`a;3--341-1Y 1CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): J b 14 V A 14 9 8 lay J Z I EVERETT BUSINESS LICENSE i(REQUIRED):(j 3:3&3 PRIMARY CONTACT: 4 OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect,Engineer,Etc.) CONTACT NAME: CONTACT PHONE: C b f'2-5-) 6,1-3 -8 5r ��'yvlL' j M 11 I2Y CONTACT EMAIL: M Ca.'r8 1 J S M a ha I'-wrn, J C om 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 law. 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 I 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# to -zozJ PVI/ 2 10 2-- er/Authorized Agent Signature Date (Revised 1172019)