2127 100TH ST SE 2024-06-14 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION 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: 2127 100th St SE Everett WA 98208 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 STORMWA TER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ 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/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) LF Proposed Roof Area: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF Clear out garbge from previous owner and removing tree stumps from rotted trees. Removed cocrete blocks, and tree branches. CONTACT INFORMATION OWNER/APPLICANT NAME: Francisco Garcia OWNER/APP. MAILING ADDRESS: STREET P.O Box 4538 CITY Everett STATE WA P98204 OWNER/APP. PHONE:425-465-7441 OWNER/APP. EMAIL:garciaf@emplreconstructlonlnc.com 'Required for Work in Public Right-of-Way CONTRACTOR NAME: Empire Construction and Remodeling inc. CONTRACTOR ADDRESS: STREETP.O Box 4538 CITY Everett STATE WA zIP 98204 CONTRACTOR PHONE:4254657441 1CONTRACTOR EMAIL:garciafp@emplreconstructlonlnc.Com CONTRACTOR LICENSE#(REQUIRED):604793752 1 EVERETT BUSINESS LICENSE#(REQUIRED): 66159 PRIMARY CONTACT: @ OWNER /APPLICANT ❑ CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:425-465-7441 Francisco G a re i s CONTACT EMAIL:garciaf@empireconstructioninc.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.l am the owner, or I am authorized by the owner of this property to perform the work for which application is made,and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Francisco Garcia 07/17/2023IPW PERMIT# Owner/Authorized Agent Signature Date (Revised 4/21/2022)