Laserfiche WebLink
PUBLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E V E R E T T <br /> SUBMITTAL INSTRUCTIONS:Emel appicatlon 8 submlt(eldmum onis to PCrmllearvlcosgovorottwa,gov or drop 01(a 13200 God or Slreel2nd Floor Drop Box <br /> WASHINGTON CONTACT INFORMATION:(P)425.257-08101(E)PermllServlcea@evorottvra.gov I(W)everettwa.govlpermits <br /> s'` Y..C',`�. 1-•1 �J Z .l 1'Ui 1 t iii:',!' t / rift i q c:y. <br /> ,�:.� ,..aY.t?.t,., ,�x�s n� (.�•,,:1?ti.�►t'o-:�► �� q• �GY.��; 1 � • �.' .N 'y`�;'t�sa�.�'+��(.�I.t�t'i'c:s ,.d��:�lt_�':�iF,�!r�V�.,,�iY% <br /> PROJECT ADDRESS; 1 <br /> SITE WORK FOR PROJECT TYPE: FR DETACHED ❑TOWNHOUSE DDUPLEX DADU DMULTI-FAMILY ❑COMMERCIAL ©INDUSTRIAL <br /> IF APPLICABLE: ❑LAND USE PROJECT#(SEPA,PRE-APP, <br /> IF APPLICABLE; []FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT ft <br /> UTILITY COMPANY'S NAXa "���u <br /> M t4V: J N: <br /> :MITMI'IVII o�:'�.,iU'�°.j4: I %1�='.�D. �.0 �p11r10 �� (� r�1�y (�'/ay� t /�r�7j /,l{�/'..//{ry ii'an t;�'(t✓ faGa� I�f ��� 1�•� <br /> �57�'11{'iX1,�.YlI{KI a. �• Il!SMfilr If'./r{Y1.VR '.,a.r�i17s'.�fna•1Cy't11f.�;�.��ik+�.Iz,4 <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> D FENCE IN ROW 3 O fi:a- Fa� FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> D DRIVEWAY APRON/CURB CUT D FT WIDE Cornbined Sewer <br /> D ASPHALT I CONCRETE PAVING . 1 o 1eli- SF ❑Separated Storm Seveer <br /> D RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish Rivor or Puget Sound <br /> D RETAINING WALL/ROCKERY OVER4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> D CLEARING I GRADING I FILL I EXCAVATE _[D_ _CY D MR2 Onty ❑MRI-5 D MR1-9 <br /> D CUT/BORE IN PAVEMENT(PARALLEL) D LF QUANTITYOFPROPOSED HARD SURFACES: <br /> D CUT/BORE IN PAVEMENT(NON-PARALLEL) 0 LF Proposed Roof Area: 1127 SF <br /> D POLE WORK I AERIAL I OVERLASH ID LF Proposed Hardscape: 1771- SF <br /> ADDITIONAL DESCRIPTION(AS NEEDED); Total Now+Replaced: SF <br /> OWNER/APPLICANT NAME: <br /> OWNER/APP, MAILING ADDRESS: STREET 1'[ <br /> 663 f4. V! <br /> p CrfY.:: l�ue� STATE w ZIP <br /> OWNER/APP.PHONE:, : ��-3� rj 'WNER/APP.EMAIL; q � C grd�os�d� i�,Go <br /> . . -- <br /> 'Required for Work In Public Rtnh+sr,"'M• \ <br /> CONTRACTOR NAME:•' r (T L I '( OtpG FlAws LLC <br /> CONTRACTOR ADDRESS: �) eTp-m 6 sq-15 9 <br /> ` <br /> cl- V G STATE.t/tJ 2p 0 <br /> CONTRACTOR PHONE: 25 a"1'� CONTRACTOR EMAIL: MOl I L V- a -4rr! �J 1G`4 <br /> /m <br /> CONTRACTOR LICENSE#(REQUIRED):M(Air,14F902,tjH JEVER&T BUSINESS LICENSE#(REQUIR ):- <br /> PRIMARY CONTACT: DOWNER /APPLICANT CONTRACTOR 0 OTHER(Archi(ect,Engineer,Etc.) <br /> CONTACT NAME; CONTACT.PHONE: <br /> 1 I CONTACT EMAIL: • i t d d 1 ,co <br /> ACKNOWLEDGEMENT.'I have rovlewed this appIICatlonnd conllrm the Information contained he Is bue and correct.Work done'flursuarit to this parmlt must <br /> comply with current federal,state,and focallai The gran Ing of a permit only authorizes approved work and no devlallons therefrom.DevlaUons must first be <br /> authorized In wrll/ng from the Building Offrclal before being authorized underany circumstance.I em the owner,orl am authorized by the owner of this property to <br /> perform the work for which application Is made,and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everoft OHlclel Use Only <br /> P <br /> a2 PW . uy 0-Lo <br /> 6;-vrlAuthortzed Agent Signature Data (Revised 4/21/2022) <br />