2611 ROCKEFELLER AVE 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 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov j https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADDRESS: 2G// 1_octC0_1e11e— 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: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE N 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 I GRADING I FILL/EXCAVATE I`9 U D CY � MR2 Only ❑ MR1-5 ❑ MRI-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: [I7 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: / Sy V SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: 9 OV 2� SF ADDITIONAL DESCRIPTION (AS NEEDED): ITotal New+Replaced: SF -"42 le�.l�J �u � ,�'� a oma✓ M ham:��.'�I - CONTACT INFORMATION OWNER/APPLICANT NAME: �l'-i f' OWNER/APP. MAILING ADDRESS: STREET CITY (J�� STATE /� ZIP OWNER/APP. PHONE: - = T OWNER/APP. EMAIL: r 2/40 lhGt• J.C�-�-, `Required for Work in Public Right-of-Way CONTRACTOR NAME: ZS M Z C On��q Chi>!S, Z_( C_ CONTRACTOR ADDRESS: S Z 03-- STREET S [yZ �6') 4v't-c- s v,: C 1' CITY 1��(/ STATE C✓r7/J ZIP CONTRACTOR PHONE: 7 Z s47 G- 7 3OJ— CONTRACTOR EMAIL: j ' . 010 b CO- lW-1 /• CO3" CONTRACTOR LICENSE#(REQUIRED): -s^ZC 0 GL 0S$t' EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ,N OWNER /APPLICANT []CONTRACTOR r'OTHER(Architect, Engineer, Etc.) CONTACT NAME:_ / L CONTACT PHONE: t./Z '5 - 7 6_ 73GS- ,S 0� /GU CONTACT EMAIL: 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 1 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 16.27 ROW and 296.200A WAC. City of Everett Official Use Only PERMIT# Zelz0, PW Owner/Authorized Agent i nature Date (Revised 1/72019)