4128 RUCKER AVE SAFEWAY 2025-01-13

Elm PRLIC WORKS PERMIT A'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:4128 RUCKER AVE. SITE WORK FOR PROJECT TYPE: ESFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU EMULTI-FAMILY []COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: E 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 ❑ Combined Sewer ❑ASPHALT/CONCRETE PAVING SF ❑ Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF El Direct Discharge to Snohomish River or Puget Sound El RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: E CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only El 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 Electric Vehicle (EV) Charging Stations:(3) Standard parking spaces to be converted to (2) EV charging stations to be installed in landscape islands adjacent to EV spaces. Electrical service to stations to be installed from existing service. EV Stalls marked and painted with signage per plans. CONTACT INFORMATION OWNER/APPLICANT NAME:Volta C/O Rick Cardoza, LDC Inc. OWNER/APP. MAILING ADDRESS: STREET 1851 Central Place S., Suite 101 CITY Kent STATE WA zip 98030 OWNER/APP. PHONE:253-218-9017 OWNER/APP. EMAIL:rcardoza@ldccorp.com *Required for Work in Public Right-of-Way l' CONTRACTOR NAME: to be determined C (!J rv1 p CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): LC iv, . 8 A EVERETT BUSINESS LICENSE#(REQUIRED): C7 ! -7 -7 4— PRIMARY CONTACT: ✓❑OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:253-218-9017 Rick Cardoza CONTACT EMAIL:rcardoza@Idccorp.com 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 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# s/p Richard B. Cardoza Digitally signed by Richard B Cardoza P V �/ 0 5— C) I Date:2022.05.16 16:3511 0T00' r V V iii�rr Owner/Authorized Agent Signature Date (Revised 1/72019) /�