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 https:Heverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:4101 Rucker Avenue Everett, WA SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ✓❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: Ll LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) EPPLI CABLE: ElFRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB M JOB# DESCRIPTION OF SITE WORK / 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 APRON/CURB CUT FT WIDE ❑ Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑ Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 ❑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): ITotal New+Replaced: SF Install five qroundwater monitorinq wells in the ROW of 41st Street as shown on the attached maps. The wells will be installed flush with grade consistinq of a steel traffic-rated monitoring well monument. CONTACT INFORMATION OWNER/APPLICANT NAME: Nick Gerkin c/o Aerotech Environmental Consulting Inc. OWNER/APP. MAILINGADDRESS: STIEET14220 Interurban Avenue S, Ste 116 CITY Tukwila STATE WA 1,98168 OWNER/APP. PHONE:206-482-2287 OWNER/APP. EMAIL:nlck@dlrtydlrt.us `Required for Work in Public Right-of-Way CONTRACTOR NAME: BOreteC 1 Inc. CONTRACTOR ADDRESS: STREETPO BOX 50525 cIn Bellevue STATE WA ZIP 98015 CONTRACTOR PHONE:509-710-9947 CONTRACTOR EMAIL:bob.boretec@gmail.com CONTRACTOR LICENSE#(REQUIRED):CC BORETI 1903PH IEVERETT BUSINESS LICENSE#(REQUIRED): 603-051-247 PRIMARY CONTACT: F11 OWNER /APPLICANT ❑ CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:2064822287 Nick Gerkin CONTACT EMAIL:nick@dirtydirt.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.1 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 1/72019)