2217 GRAND AVE 2024-07-16 - Laserfiche WebLink

I PUBLIC WORKS PERMIT APPLIC EOVE `: CITY OF EVERETT PERMIT SERVICES EV E R E T T SUBMITTAL INSTRUCTIONS:Email application&submittal documents to PernlllServlees@everethva.gov or dlat 320 ftloarIlget$pgloor Dro WASHINGTON CONTACT INFORMATION:(P)425-257-88101(E)PermitServices@everettwa.go I(IN)evellrllet�ltVVwa.govv/permi(s PROJECT SITE INFORMATION iY V L PROJECT ADDRESS: ZZ( & , ,li — qe r - GL 'I /-wf V Il Is SITE WORK FOR PROJECT TYPE:VSFR-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 M 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 ❑Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑Separated Storm Sewer ❑ RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound VNQ�l2 11RETAINING WALL/ROCKERY(nW4FT 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): Total New+Replaced: SF LZ . I CONTACT INFORMATION OWNER/APPLICANT NAME: t ,v - ; )LLX OWNER/APP. MAILING ADDRESS: STREET 2 / CITY STATE ' q ZIP OWNER/APP.PHONE: OWNER/APP.EMAIL: 'Required for Work in Public Right-of-Way CONTRACTOR NAME: t CONTRACTOR ADDRESS: STREET103 0 3 0 5' `'I D 1 � 'LL, & CITY LcI (,Q STATE WA ZIP �LS CONTRACTOR PHONE: (c q CONTRACTOR EMAIL: g 6 f I CONTRACTOR LICENSE#(REQUIRED): _4-L� - f- I W Z L EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: PROWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: t/2 5- 3 3 0 y . 0 A-/J eT 16 v C'% 1CONTACT EMAIL: • A 6G C G ACKNOWLEDGEMENT.•l 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 OnlyPERMIT# L_ � PW X06 - o�(;I- Ow—ne A thorized Agent Signature Date (Revised 4/21/2022)