10615 21ST PL W 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 FAX 425-257-8857 1 (E)everetteps@everettwa.gov https://everettwa.gov/permits PROJECT SITE INFORMATION :, PROJECT ADDRESS: /1- / fV r,& SITE WORK FOR PROJECT TYPE: SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU []MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) DESCRIPTION OF SITE WORK'l"RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: (DRIVEWAY APRON/CURB CUT 2j0 FT WIDE 13 Combined Sewer `I ASPHALT/CONCRETE PAVING e��l 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 I FILL/EXCAVATE CY ❑ MR2 Only ❑MR1-5 ❑ 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 I AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF uc6Ue iSfi'R Ki'Va(4,)0 -4 CONTACT INFORMATION OWNER/APPLICANT NAME: Yu' FI o -12C dl OWNER/APP. MAILING ADDRESS: STREET 1OV[16 / CITY Eye 0�,Q 7 STATE [/!/ ZIP OWNER/APP. PHONE; OWNER/APP.EMAIL:n0 T a k�f LL10 10 cla hoc, O 'Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: ICONTACT PHONE: C)w f� cv- ICONTACT EMAIL: ACKNOWLEDGEMENT:1 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# 09 i3, aoa� PW 21 C�9--azo Owner/Authorized Agent Signature Date (Revised 4/15)2019)