10115 HOLLY DR OLIN FIELDS APTS 2024-07-02

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitServices@eveTLglwa.gav or drop off at 3200 Cedar Street 2nd Floor Drop Box EVERETT WASHINGTON , CONTACT INFORMATION:(P)425-257-88101(E) �mitSee ices@everettwa. I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 01i /yv/c;/5 4 r-7-. /D//S SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) L A- IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT#- NIA- UTILITY COMPANY'S NAME&JOB#: I✓A//A JOB M DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: FENCE IN ROW 7�D �f F 6 //7' FT IN HEIGHT STORMWATER 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 1 ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING I GRADING/FILL I 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): Total New+Replaced: SF / CONTACT INFORMATION OWNER/APPLICANT NAME: Aov = cZ OWNER/APP. MAILING ADDRESS: STREET tl M� r,� /cue131'dl , CITY STATE p ZIP OWNER/APP.PHONE: Zf^Z 59-6 5�`I? OWNER/APP. EMAIL: P `Required for Work in Public Right-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 41011 3"/-A S m Q CITY // 140 ' �y// / e A / STATE G/ �� ZIP CONTRACTOR PHONE: C!ONyTRACT/ORE,MAIL: � g�)> 6 r CONTRACTOR LICENSE#(REQUIRED): �'Ir0,�0(r / � S� //,� EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER /APPLICANT CONTRACTOR ❑OTHER(Architect, Engineer,Etc.) CONTACT NAME: CONTACT PHONE: 'j ICONTACT EMAIL: ACKNOWLEDGEMENT:I have reviewed thi 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.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. City of Everett Official Use Only PERMIT# 3 � z MA/ 6 � �1 9 Owner/Authorized Agent Si ature Dat (Revised 4/21/2022)