4101 RUCKER AVE 2024-03-29 - 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 hftps:Heverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:41 01 Rucker Avenue Everett, WA 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-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑ ASPHALT / CONCRETE PAVING SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK / AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: ❑ Combined Sewer ❑ Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF Total New+ Replaced: SF Install five qroundwater monitoring wells in the ROW of 41st Street as shown on the attached maps. The wells will be installed flush with qrade consistinq of a steel traffic -rated monitorinq well monument. CONTACT INFORMATION OWNER/APPLICANT NAME: Nick Gerkin c/o Aerotech Environmental Consulting Inc. OWNER/APP. MAILING ADDRESS: ITREET14220 Interurban Avenue S, Ste 116 CITY Tukwila STATE WA ZIP 98168 OWNER/APP. PHONE:206-482-2287 OWNER/APP. EMAIL: nick@dlrtydlrt.us *Required for Work in Public Right -of -Way CONTRACTOR NAME: BOreteC 1 Inc. CONTRACTOR ADDRESS: STREETPO BOX 50525 , Bellevue STATE WA ZIP 98015 CONTRACTOR PHONE:509-710-9947 1CONTRACTOR EMAIL: bob.boretec@gmall.com CONTRACTOR LICENSE #(REQUIRED): CC BORET11903PH IEVERETT BUSINESS LICENSE#(REQUIRED): 603-051-247 PRIMARY CONTACT: OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Nick Gerkin CONTACT PHONE: 2064822287 ICONTACT EMAIL: nick@dlrtydlrt.us 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 # 07/19/2021 IPW Owner/Authorized Agent Signature Date (Revised 1172019)