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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 l FAX 425-257-8857 l (E) everetteps@everettwa.gov l https://everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 2030 Melvin Ave, Everett, WA 98203 <br />SITE WORK FOR PROJECT TYPE: ❑✓ SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX []ADU ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SERA, PRE-APP, SS, ETC.) <br />IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # <br />UTILITY COMPANY'S NAME & JOB #: JOB # <br />DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />L7 FENCE IN ROW 6 FT IN HEIGHT <br />❑ DRIVEWAY APRON / CURB CUT FT WIDE <br />❑ ASPHALT / CONCRETE PAVING SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF <br />❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT <br />❑ CLEARING / GRADING / FILL / EXCAVATE CY <br />❑ CUT/BORE IN PAVEMENT (PARALLEL) LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF <br />❑ POLE WORK / AERIAL / OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDED): <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />[I Combined Sewer <br />❑ Separated Storm Sewer <br />❑ Direct Discharge to Snohomish River or Puget Sound <br />TRIGGERED REQUIREMENTS: <br />D MR2 Only ] MR1-5 ❑ MR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Roof Area: SF <br />Proposed Hardscape:___ SF <br />Total New + Replaced: SF <br />Privacv fence located at the back of property, partially located in undeveloped alleyway. Roughiv 4 <br />feef;into ROW. <br />CONTACT INFORMATION <br />OWNER / APPLICANT NAME: Melissa LaPier <br />OWNER / APP. MAILING ADDRESS: STREET 2030 Melvin Ave <br />CITY Everett STATE WA ZIP 98203 <br />OWNER / APP. PHONE: 425-232.-8974 <br />OWNER I APP. EMAIL: melissaekelly@live.com <br />'Required for Work in Public Right -of -Way <br />CONTRACTOR NAME: N/A <br />CONTRACTOR ADDRESS: STREET <br />GnY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: O OWNER I APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: (� <br />Melissa Laf ier <br />CONTACT PHONE:425-232-8974 <br />CONTACT EMAIL: melissaekelly@live.com <br />ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br />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 <br />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 <br />perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />(LIC-4_ ii ��p 10/21/2021 PLW <br />Owner/Authorized Agent Signature Date (Revised 1172019) <br />