4721 BAYVIEW LN 2024-10-24 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS: Email application & submittal documents to PermilServices@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 MOJECT SITE: INFORMATION" .2.0 . PROJECT ADDRESS: 21 IV 1i0 /nl_r it"d SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT It (SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB #: JOB #: '`DESCRIPTION'OF`.SIT'E.WORK /.RIGHT�OFiV11AY tYVORK. - FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ' ❑ FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: ❑ DRIVEWAY APRON I CURB CUT FT WIDE ❑ Combined Sewer ❑ ASPHALT / CONCRETE PAVING 700)-120 SF ❑ Separated Storm Sewer ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑ CLEARING I GRADING I 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: 7,00 580 SF /- P///j r 14,PR��v tvb I - d 2 MIT VC)d P,, T016d4T ✓�' �� Iv" /) L11jv 'L Walkway area under B2311-067 -' CONTACTS INFOFtMAT10N � OWNER / APPLICANT NAME: YA fv IV .- OWNER / APP. MAILING ADDRESS: STREET b1 / V /f_ n2 / CITY V � (fr STATE YV / ZIP I Q p2 Q f OWNER /APP. PHONE: �� %QG ^� 0(0 2 OWNER / APP. EMAIL: /\ iljIV hI �lj% j `Required for Work in Public Right -of -Way — CONTRACTOR NAME: D [EC E CONTRACTOR ADDRESS: STREET CITY STATE NOV 2 7 2023 CONTRACTOR PHONE: CONTRACTOR EMAIL: CITY OF EVERETT CONTRACTOR LICENSE #(REQUIRED); EVERETT BUSINESS LICENj Permit Services PRIMARY CONTACT: OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: / \J �'v Gv %�6 CONTACT PHONE: -2 0,-- • CONTACT EMAIL: ACKNOWLEDGEMENT., 1 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. /d/,, )Gyv horized Agent Sfgnature City of Everett Official Use Only 7PW �VI202 �� l I 0cc) Date (Revised 412112022)