10524 13TH AVE W 2024-12-02 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EV E R E T T SUBMITTAL INSTRUCTIONS Email•pplcainn S submittal documents to PerrnitServiceseaverettua gov or drop offal 3200 Ceder Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)Penni(Servlces®everettwa gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:10524 13th AVE W SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED []TOWNHOUSE ❑DUPLE( ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC)PW1807-010 IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB#: DESCRIPTION OF SITE WORK if 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: R DRIVEWAY APRON/CURB CUT 20 FT WIDE ❑Combined Sewer R ASPHALT/CONCRETE PAVING 1300 SF E 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 I GRADING/FILL/EXCAVATE CY ❑MR2 Only ❑MR1-5 GIMR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area 5033 SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:3057 SF ADDITIONAL DESCRIPTION AS NEEDED): Total New-Replaced 8090 SF CONTACT INFORMATION OWNER/APPLICANT NAME:LAKHJIT GREWAL 11 OWNER/APP. MAILING ADDRESS: STREET ' crly rIA, A( STA-E ziP l K? s OWNER/APP.PHONE:425.750.5539 OWNER/APP.EMAIL:Iakhjitgrewal@gmail.com 'Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CnY STAT= L'P CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE$(REQUIRED): PRIMARY CONTACT: IN OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: OS E P H S M E BY CONTACT PHONE:425.903.4852 CONTACT EMAIL:joe@omegatng.com ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this perm t 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 I 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 9 City of Everett Official Use Only 8/8/22 pW OwnerIA orized Agent Slgnaturo Date (Revised 4/21/2022)