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EVERETT <br />PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 2931 Grand Avenue <br />SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE [-]DUPLEX ❑ADU ❑MULTI -FAMILY ❑✓ COMMERCIAL ❑INDUSTRIAL <br />IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, 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 I RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />❑✓ FENCE IN ROW 7 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 / 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 />❑ Combined Sewer <br />❑ Separated Storm Sewer <br />173 Direct Discharge to Snohomish River or Puget Sound <br />TRIGGERED REQUIREMENTS: <br />❑ MR2 Only ❑ MR1-5 ❑ MR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Proposed Roof Area: SF <br />Proposed Hardscape:_ SF <br />jTotal New + Replaced: SF <br />Install 46 lineal feet of 7' tall chainlink fencinq with 20' wide gate with <br />automation and 3502 knox switch. <br />CONTACT INFORMATION <br />OWNER / APPLICANT NAME: Morrie Trautman <br />OWNER / APP. MAILING ADDRESS: STREETPO Box 1447 <br />CITY Everett STATE WA ZIP 98206 <br />OWNER / APP. PHONE: 206-484-981 1 <br />OWNER / APP. EMAIL: <br />'Required for Work in Public Right -of -Way <br />CONTRACTOR NAME: Economy Fence Center <br />CONTRACTOR ADDRESS: sTREET11709 Cyrus Way <br />c,Ty Mukilteo STATE WA ZIP 98275 <br />CONTRACTOR PHONE:425-347-1355 <br />1CONTRACTOR EMAIL: dwayne dwayne@economyfence.com <br />CONTRACTOR LICENSE #(REQUIRED): ECONOFC798KS <br />IEVERETT BUSINESS LICENSE #(REQUIRED): 40814 <br />PRIMARY CONTACT: ❑ OWNER I APPLICANT ❑✓ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: <br />Dwayne Hopper <br />CONTACT PHONE:425-347-1355 <br />CONTACT EMAIL:dwayne@economyfence.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 �contply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />01 Zo2Z IPW <br />Agent Signature Date (Revised 1172019) <br />