9227 4TH AVE W 2024-08-12 - 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 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:9227 4Th AVE W Everett,WA 98204 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE DUPLEX ❑ADU DMULTI-FAMILY DCOMMERCIAL DINDUSTRIAL IF APPLICABLE: El 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 FT IN HEIGHT STORMWATER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer B ASPHALT/CONCRETE PAVING 3254 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: B CLEARING/GRADING/FILL/EXCAVATE 210 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.3423 SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:3254 SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced:6779 SF CONTACT INFORMATION OWNER/APPLICANT NAME:Adis Zizak OWNER/APP. MAILING ADDRESS: STREET 1104 178th ST SW CITY Lynwood STATE WA ZIP 98037 OWNER/APP. PHONE:425-268-251 5 OWNER/APP. EMAIL:napandesign@gmall.com `Required for Work in Public Right-of-Way CONTRACTOR NAME: Napa Homes LLC CONTRACTOR ADDRESS: STREET 1104 178th ST SW CITY Lynnwood STATE WA zip 98037 CONTRACTOR PHONE:425-268-2515 CONTRACTOR EMAIL:napandesign@gmall.COm CONTRACTOR LICENSE#(REQUIRED):NAPAHHL798JM EVERETT BUSINESS LICENSE#(REQUIRED): 64947 PRIMARY CONTACT: B OWNER /APPLICANT ❑CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:425-268-2515 Adis Zizak CONTACT EMAIL:Napandesign@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 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 IZZ /Z-Z. /�vPERMIT#PW • Owner/Authorized Agen gnature Date (Revised 4/21/2022)