1710 100TH PL SE 2024-06-25 - Laserfiche WebLink

moo PI LIC WORKS PERMIT ALICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitServices@everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 I (E)PermitServices@everettwa.gov I (W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:1710 100TH PL SE EVERETT, WA 98208 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU MULTI-FAMILY BCOMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: El 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 ❑ Combined Sewer ❑ASPHALT/CONCRETE PAVING SF 8 Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF 0 Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) 7.8 LF Proposed Roof Area: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION (AS NEEDED): Total New+Replaced: SF INSTALL (2) 3" PVC PIPES (21 LF) FROM EXISTING PUMPSTATION IN PARKING LOT TO FLOW LINE AT GUTTER IN 16TH AVE SE CONTACT INFORMATION OWNER/APPLICANT NAME:JIM SCHUMACHER OWNER/APP. MAILING ADDRESS: STREET PO BOX 949 ciTv MUKILTEO STATE WA ZIP 98275 OWNER/APP. PHONE:206-715-9000 OWNER/APP. EMAIL:Jim@LeasingRealestate.com `Required for Work in Public Right-of-Way CONTRACTOR NAME: The LAND DESIGN COMPANY/ Scott Helm CONTRACTOR ADDRESS: STREET 17906 12TH AVE NW c,Ty Arlington STATE WA ZIP 98223 CONTRACTOR PHONE:425-220-5341 CONTRACTOR EMAIL:Land.design@IIve.com CONTRACTOR LICENSE#(REQUIRED):LANDD**011 BL EVERETT BUSINESS LICENSE#(REQUI 2 D): TBA PRIMARY CONTACT: El OWNER /APPLICANT ❑ CONTRACTOR 0 OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:206-715-9000 Jim Schumacher CONTACT EMAIL:Jim@LeasingRealestate.com 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# May 29, 2022 PW 21-0C — DO c, Own r/Aut rized Agent Signature Date (Revised 4/21/2022)