3121 LOMBARD AVE C 2024-07-01 - 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 1(E)PermitServices@everettwa.gov i(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:3121 Lombard Ave. unit C Everett, WA 98201 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 4 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): ITotal New+Replaced: SF 30 ft L x 4 ft H Vinyl fence located in the right-of-way CONTACT INFORMATION OWNER/APPLICANT NAME:Aliaksandr Siniak OWNER/APP. MAILING ADDRESS: STREET 3121 Lombard Ave. unit C CIT., Everett STATE WA ZIP 98201 OWNER/APP. PHONE:2069453426 OWNER I APP. EMAIL:siniak.sasha@gmail.com `Required for Work in Public Right-of-Way CONTRACTOR NAME: Maksymov Brownstone LLC CONTRACTOR ADDRESS: STREET 33616 55th Ave S CITY Auburn STATE WA ZIP 98001 CONTRACTOR PHONE:253.394.8774 CONTRACTOR EMAIL:Igmaksymov@gmall.com CONTRACTOR LICENSE#(REQUIRED):MAKSYBL809B7 EVERETT BUSINESS LICENSE#(REQUIRED): MAKSYBL809B7 PRIMARY CONTACT: @ OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:206-945-34-26 Alexander CONTACT EMAIL:siniak.sasha@gmail.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. 1 am the owner,or l 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. City of Everett Official Use Only AGIaksaildv Si�rr k 07-30-2023 pW# Owner/Authorized Agent Signature Date (Revised 4/21/2022)