6120 LOMBARD AVE 2024-12-02 - 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 1(E)Perm itServices@everettwa.gov I (W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADDRESS:6120 Lombard Ave Everett Wa 98203 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) Tree removal and water line reblac( IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB M 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 STORMWA TER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ 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: 8 CLEARING/GRADING/FILL/EXCAVATE 1 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 Remove tree and roots impacting waterline and waterline repair/replacement. Actual area of waterline break is 6132 Lombard Ave. Owner has given permission for tree removal. This break has been discussed by Everett Water. The only way to access and iepaii is removal of iouts and hee. CONTACT INFORMATION OWNER/APPLICANT NAME: Amanda Good OWNER/APP. MAILING ADDRESS: STREET6120 Lombard Avenue CITY Everett STATE WAA ZIP 98203 OWNER/APP. PHONE:5098185725 OWNER/APP. EMAIL:amandamaood(@amail.com "Required for Work in Public Right-of-Way CONTRACTOR NAME: Arbor Cascade LLC CONTRACTOR ADDRESS: STREET 10927 29th St NE CITY Lake Stevens STATE wa ZIP 98258 CONTRACTOR PHONE: (425)344-6880 1CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): ARBORC*962QN IEVERETT BUSINESS LICENSE#(REQUIRED): 61 842 PRIMARY CONTACT: 8 OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) RClll CU rdll ICI U CONTACT NAME:Al Good CONTACT PHONE: (425)742-1 949 CONTACT EMAIL:ciclly..UUUIL.VUUI I IlUdbL.I ICL 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 1 am authorized by the owner of this property to perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 6/26/22 PW# Owner/Authorized Agent Signature Date (Revised 412112022)