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PRLIC WORKS PERMIT ALICATION CITY OF EVERETT PERMIT SERVICES O� 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3533 (.J6,5SFt. S t �Jci e. t-+, (OW 9e3Z-0 SITE WORK FOR PROJECT TYPE: RSFR-DETACHED ❑TOWNHOUSE ❑DUPLEX EADU OMULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE:- DRAINAGE MITIGATION QUESTIONS: VFENCE IN ROW t4Z" rim/ r I (gf FT IN HEIGHT STORMWATER DISCHARGES TO: 0 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 0 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 Ln�P U, eSt.r -oc-.nd.nj CONTACT INFORMATION OWNER/APPLICANT NAME: jnytc 35 L cAII S OWNER/APP. MAILING ADDRESS: STREET pc, 5o YL /2 7 I'1 C� ` CITY ,Q/�-- r" STATE � t ZIP 9VZOC- OWNER/APP. PHONE: +ZS"330 -245"1 OWNER/APP. EMAIL:V ant SS a @ ilekc}hSoulne(,rPS"hipr( cn V 1 1tto • LOr `Required for Work in Public Right-of-Way CONTRACTOR NAME: 'QI(--h S id 12eS-thra.:±t CONTRACTOR ADDRESS: STREET Y0 x CITY E.\)Q.( ±+ STATE ZIP 9 e m./ CONTRACTOR PHONE: i{�,j. d- 2c{5'� CONTRACTOR EMAIL: V0k.fP5sig e1(\p /1-V) C es-to r".'h pry.' Low CONTRACTOR LICENSE#(REQUIRED): N O -SQY7Le 69 EVERETT BUSINESS LICENSE#(REQUIRED) PRIMARY CONTACT: OWNER /APPLICANT 0 CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: 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 w om 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 ork for hich 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# PW 101010Li Owner/Authorized Agent Signature Da e (Revised 1/72019)