716 33RD ST 2024-03-27 - Laserfiche WebLink

i i PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov https://everettwa.gov/permits RROJECT..SITC INFORMATION PROJECT ADDRESS: l OZ_f r__\jc_-7ACT-r 7- SITE WORK FOR PROJECT TYPE: ( SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK°/RIGHT-0FMAY WORK; FILL IN ALL QUANTITIES OF WORT(BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORM WATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT t FT WIDE ❑Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑Separated Storm Sewer ❑RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL 1 ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE CY ❑MR2 Only ❑MRf-5 ❑MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUTIBORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑POLE WORK I AERIAL I OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION AS NEEDED): ITotal New+Replaced: SF CONTACT`iNFORMATION OWNER I APPLICANT NAME: i�3 l Y� o c--�j t..JG 91,4&-tq OWNER/APP. MAILING ADDRESS: sTREeT1 6 3 A-1) 5� # CnY J"W A e7 T STATE ZIP C� � OWNER I APP.PHONE: OWNERIAPP. EMAIL: 2(c ( 'cJ�7 tt3ti�vaa, rt "Required for Work In Public Right-of-Way CONTRACTOR NAME: ��,d f� v� /� � , t. R,5 T L-l� CONTRACTOR ADDRESS: STREET r �1 f�{ L�:� ]) f CITYJ( & "Y "4 L_V1_ STATE U-'1-�' ZIP q"y€d/ CONTRACTOR PHONE: f Z_C4� 4 ONTRACTOREMAIL: CONTRACTOR LICENSE#(REQUIRED): C EVERETT BUSINESS LICENSE#(REQUIRED): c PRIMARY CONTACT: ®OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer,Etc.)' CONTACT NAME CONTACT PHONE: 0 CONTACT 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 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 PERS PW # P V V 2- 0 G 033 OwnerlAuthorize'd Agent Signature Date (Revised 1/72019)