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

• • ix '4 PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS Email applcat}on S submittal documents to PamtitSarvicasaeverattwa pov or drop off at 92t/0 Cedar Street 2nd Hoar Crop @ok CONTACT INFORMATION;(P)425-257-881O 1(E)PermttServlces©everettwa.gov I(W)everet(wa.gov/permlta : WASHINGTON PROJECT SITE INFORMATION PROJECT ADDRESS:10524 13th AVE W SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL ,IF APPLICABLE: ®LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC)PW1807-010 IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB Mt JOB#: DESCRIPTION OF SITE WORK I 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 20 FT WIDE 0 Combined Sewer ®ASPHALT/CONCRETE PAVING 1300 SF III 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 0 MR2 Only 0 MRI-5 0 MRT-g ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area:5033 SF El POLE WORK/AERIAL!OVERLASH LF Proposed Hardacape:3057 SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New Replaced:8090 SF i 1 CONTACT INFORMATION OWNER/APPLICANT NAME:LAKHJIT GREWAL �( j� OWNER l APP. MAILING ADDRESS: em Er �,1;2") C�Ly —'--�—'crrY ti@1 I STATE \All nP Cl g2De OWNER!APP.PHONE:425,750.5539 OWNER I APP.EMAIL:Iakhjitgrewal@gmail.Com 'Required for Work In Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: _ EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR LICENSE#{REQUIRED): PRIMARY CONTACT: III OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect,Engineer,Etc.) CONTACT NAME: CONTACT PHONE:425.903.4852 J S E P H S M E B Y CONTACT EMAIL:joe@omega-cng.com ACKNOWLEDGEMENT 1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this pemut 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!am authorized by the owner of this properly to perform the work for which application is made,and I comply with the State Contractors Law 18,27 ROW and 298.200A WAC. City of Everett Official Use Only 8/8/22 PPW \SO' - 0 C OwnerlA orized Agent Signature Date (Revised 441/2022)