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PUBLICPERMIT APPLIGATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 ovi ©rmlts EVERETT wa. ov lltlps://evoro((WO.gov/pormlts 257-8810 FAX 425-257-8857 (E) ovorottops@everetl g WASHINGTON (P} 425 � : - PROJE T SITE INFORMATION ` PROJECT ADDRESS. 0U� - ADU []MULTI-FAMILY []COMMERCIAL ❑INDUSTRIAL- SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ IF APPLICABLE: U LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISF_/UTILITY COMPANY, ANNUAL BLANKET PERMIT #! UTILITY COMPANY'S NAME & JOB #: JOB # TE WORK / RIGHT=OF=WA►Y WORK _ ,ORSCMPTION-O SI CATION QUEsMNS: FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: DRAINAGE MITI F1' IN HEIGHT STORAAWATER DISCHARGES TO: C] FENCE IN ROW ❑ DRIVEWAY APRON I CURB CUT FT WIDE ❑ Combined Sewer 11 ASPHALT / CONCRETE PAVING SF ❑ Separated Storm Sewer RIGHT-OF-WAY LF ❑ Direct Discharge to Sno acnlsh River car Puget Sound Ll RETAINING WALL / ROCKERY IN RI - ERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: [] RETAINING WALL / ROCK _ _ CY MR2 Only ❑ MR1-5 ❑ MRI-9- 00' / GRADING / FILL / EXCAVATE : ---------- - CUT ORE IN PAVEMENT (PARALLEL) LF QUAN77TY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT (NON-PARALLEL) -� Lf Proposed Roof Area: SF U POLE WORK / AERIAL 1 OVERLASH LF Proposes 1-tardscape: SF ADDITIONAL DESCRIPTION AS NEEDED): ITolal New ♦ Replaced. SF CONTACT INFORMATION OWNER I APPLICANT NAME: P OWNER / APP. MAILING ADDRESS. Sl REL f «rY L -e Pe s1A z>P 740 1 G OWNER I APP. PHONE: 2 "_ 492Q Z � JOWNER /-APP. FJWL: 1 �� L � �'' • C 'fired far Wrwk in Putfic FOOIW-Way ay COWRACTOR NAME: all PILvi b I a M �- CONTRACTOR ADDRESS: atter T 6 _ cm WaIR WAM ter CONTRACTOR PHONE; CONTRACTOR EMAIL.- CONTRACTOR LICENSE QUIRED • �� Ll { � � EVERETT BUSINESS LICENSE #(REQLARED): 15 PRJMARY CONTACT: [ ] C)WI R I A,PPI�ICANT ❑ CONTRACTOR ❑ OTHER (ArcNiect, Erngkww, Etc.) TACT NAME. CONTACT PHONE. CONTACT EMAIL: AOIKAVMi : l PIMN nrv*"W 8 app or N1 conikm ixArl2Mtn om*~henM is Irm and couml. Work done pursuant k) IM penT91 rnuat wa poly wNh aurn" bdm* AWk OW WWAfty, The prsn+*u of a pariah ctiW suit -Azos Vpwvoal woM and no awvwions lhafnmm. D®vl kins inusl Ifrst bo 1 in wrtbV /Ian ftp R&Wft CAW boOme beN'ttgr aughwaad unujar Ong dwim staMs. I SM ft Omw, or I sm auffioA*d by thv cawwf of Ws properly fo t rm &a WW* faMidb, ond I rr #v L4Nh this ;aIle 04nlrailarts Lsw 48.2/ f Y and n&A)OA WAC. { C1dfY of kwWall Olrlcfsl t.Aw Orrty PERMIT PW + ►a . - ..x 0wo (Revised 1/1209)