3102 ROCKEFELLER AVE 2024-03-29 - Laserfiche WebLink

EVERETT PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https://everettwa.gov/permits FORM�I�N PROJECT ADDRESS:3102 Rockefeller Avenue EVC!!ng Q r SITE WORK FOR PROJECT TYPE: 7SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY MMERCIAL ❑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 BE PPLICABLE: S/* FENCE IN ROW 2„411K W�� G' FT IN HEIGI T A ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑ ASPHALT / CONCRETE PAVING SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK / AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: Combined Sewer ❑ Separated Storm Sewer n Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF Total New + Replaced:_ SF y A010 ri CONTACT INFORMATION OWNER I APPLICANT NAME: 0 P/� %j,It /2 OWNER / APP. MAILING ADDRESS: STREET 3�O �.�yO/-C.GQ n CITY il4e V/ STATE V� ZIP 2 OWNER / APP. PHONE: ZJ 4 Z� Z S / OWNER I APP. EMAIL: rwwtck Reau,reo for Work in Public Right -of -Way /I _J �r / CONTRACTOR NAME: LilaL IA a e r_e,,, G /'�G CONTRACTOR ADDRESS: STREET -/ Z STATE (/ zip O CITY ic L, CONTRACTOR PHONE: ( CONTRACTOR EMAIL: CONTRACTOR LICENSE ff(REQUIRED): IEVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:�r �« jjs CONTACT 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 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 18.27 RCW and 296.200A WAC. Owner/Authorized Agent Signature City of Everett Official Use Only PERMIT # Iv ?,� Z"Z- PW e (Revised 1172019)