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PtLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br /> WASHINGTON (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:5109 Chinook Dr Everett Wa 98203 <br /> SITE WORK FOR PROJECT TYPE: ESFR-DETACHED ❑TOWNHOUSE ['DUPLEX ❑ADU EMULTI-FAMILY ['COMMERCIAL ['INDUSTRIAL <br /> IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) <br /> IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> [' FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer <br /> ❑ASPHALT/CONCRETE PAVING SF ❑ Separated Storm Sewer <br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF El Direct Discharge to Snohomish River or Puget Sound <br /> ✓❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT 65" FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only El MR1-5 ❑ MR1-9 <br /> ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF <br /> ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:_ SF <br /> ADDITIONAL DESCRIPTION (AS NEEDED): Total New+Replaced: SF <br /> Proposed 2 X 100" walls running N-S, remains under 4' until the last 26 ' of the northend where property <br /> has a natural drop-off ending at 65". Proposal of the installation of Geotextile webbing on wall blocks <br /> from 50' line north towards natural slope to address extra stress caused by extra soil behind both walls <br /> CONTACT INFORMATION <br /> OWNER/APPLICANT NAME:Arlen & Karen Bradley <br /> OWNER/APP. MAILING ADDRESS: STREET5109 Chinook Dr. <br /> CITY Everett STATE WA ZIP 98203 <br /> OWNER/APP. PHONE:2065524388 OWNER/APP. EMAIL:turner1959@yahoo.com <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑✓ OWNER /APPLICANT 7 CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: (:)6 - j 5 2 - 3/3 <br /> rccc.C 'e CONTACT EMAIL: 1% rrtc: 19'�'l �J y,, <br /> ACKNOWLEDGEMENT I have reed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br /> 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 <br /> 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 <br /> perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> i , / PW )..Ak C'V 3•wnerti thorized A ent Si. Date (Revised 1/ 19) <br />