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PLIC WORKS PERMIT PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov i https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:4916 24th Ave. W., Everett, WA 98203 <br /> SITE WORK FOR PROJECT TYPE: ❑✓SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU EMULTI-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 / RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> ©DRIVEWAY APRON/CURB CUT 12 FT WIDE ❑Combined Sewer <br /> ASPHALT/CONCRETE PAVING 937 SF ❑✓ Separated Storm Sewer <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF El Direct Discharge to Snohomish River or Puget Sound <br /> El RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> ©CLEARING/GRADING/FILL/EXCAVATE 200 CY ❑MR2 Only ❑MR1-5 ❑MR1-9 <br /> Cl CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area:2157 SF <br /> Cr]POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:937 SF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:3094 SF <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME:4900 24th Ave W., LLC <br /> OWNER/APP. MAILING ADDRESS: STREET 526 N. West Ave. #147 <br /> CITY Arlington STATE WA ZIP 98223 <br /> OWNER/APP.PHONE:360-631-5922 x 3 OWNER/APP. EMAIL:officemanager@fullwilerconstruction.com <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: FullWller Construction Inc. <br /> CONTRACTOR ADDRESS: STREET same as above <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE:same as above CONTRACTOR EMAIL:same as above <br /> CONTRACTOR LICENSE#(REQUIRED):FULLWCI903M2 EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER /APPLICANT ✓❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE:360-631-5922 x 3/425-344-7803 <br /> Mallorie Hefley or Jerry Fullwiler CONTACT EMAIL:officemanager@fullwilerconstruction.com <br /> ACKNOWLEDGEMENT:1 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 /> bi1q/Z67( PW 2coCa 3 <br /> Owner/Authorized Agent Sig ature Date (Revised 1/72019) <br />