2611 ROCKEFELLER AVE ROCKEFELLER SQUARE 2 2024-08-12

uni PLILLIC WORKS PERMIT Al LICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: '26i/ /2..ct4(Q7tc'// . i"/71 / fr�4/(Ife7/, "/�j GOI 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 FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE A 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: .1KI CLEARING/GRADING/FILL/EXCAVATE (n)0 CY ❑ MR2 Only El MR1-5 ❑MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES:E ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: / 5 /U SF El POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: 9 UO SF ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF Pe 4)51t , ext.s1,„) or L.,(Arts, 0 ,6 ,- `r 01/.1 ✓ 6:-171- ht-ii; . / /1 ts(9 w(ec r-N .�� /e4„,dsc</4 s.,Ie, 0)1IlA.AkIlA r P .. ) Q.in.�;N?!� ho Inn+..! also CONTACT INFORMATION4,4'6 OWNER/APPLICANT NAME: 6.'/4 OWNER I APP. MAILING ADDRESS: STREET S a Cc- j , 2 (,) . { 7 Sa . C CITY C (l e��// . STATE L. ZIP 9',6Zc73 OWNER/APP. PHONE: '-iZ S-176• 7 31-'S OWNER/APP.EMAIL: ' 2,4 4 s="l7<1• C� 4-, *Required for Work in Public Right-of-Way CONTRACTOR NAME: -S /3 1 Z Con/V q C'it.-S, CONTRACTOR ADDRESS: 5 2 0 3- STREET Z 'r 1 CITY G of STATE 1✓/7 ZIP `, CONTRACTOR PHONE: 9 Z S-P176.. 7 3G27 CONTRACTOR EMAIL: ax2-• Z/ b q/`'rn./• CO A-t CONTRACTOR LICENSE#(REQUIRED): .�•�►ZCO GL 65? EVERETT BUSINESS LICENSE#(REQUIRED): S LI i PRIMARY CONTACT: 'El OWNER /APPLICANT ❑CONTRACTOR El OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: Le Z. -S?6__ 7305— OL I CONTACT EMAIL: wP, Z. /46 L p"��,, /, ccn..1 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. 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 ROW and 296.200A WAC. City of Everett Official Use Only PERMIT# -Ze/— Zti6° PW 21 Di- 01,, Owner/Authorized Agent i nature Date (Revised 1/72019)