4101 RUCKER AVE 2024-12-02 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I https:/Ieverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:4101 Rucker Avenue Everett,WA SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE []DUPLEX QADU []MULTI-FAMILY (]COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) EPPL ICABLE: ElFRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK I RIONT-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 Q Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING I FILL I EXCAVATE CY ❑MR2 Only Q MR1-5 ❑MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: ❑CUTIBORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION(AS NEEDED): ITotal New+Replaced: SF Repair surface monuments of groundwater monitoring wells in the ROW of 41st Street as shown in the attatched map. Previously installed under permit PW2107-041. CONTACT INFORMATION OWNER/APPLICANT NAME: Justin Foslien c/o Aerotech Environmental Consulting Inc. OWNER/APP. MAILING ADDRESS: ITREIT14220 Interurban Avenue S, Ste 116 cnY Tukwila STATE WA z,P 98168 OWNER/APP.PHONE:206-482-2287 OWNER/APP.EMAIL:justin@dirtydlrt.uS `Required for Work in Public Right-of-Way CONTRACTOR NAME: BOreteC 1 Inc. CONTRACTOR ADDRESS: STREETPO BOX 50525 c,Ty Bellevue STATE WA ZIP 98015 CONTRACTOR PHONE:509-710-9947 CONTRACTOR EMAIL:bob•boretec@gmail.com CONTRACTOR LICENSE#(REQUIRED):CC BORETI 1903PH EVERETT BUSINESS LICENSE#(REQUIRED): 603-051-247 PRIMARY CONTACT: i]OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:2067151626 Justin Foslien CONTACT EMAIL:justin@dirtydirt.us 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# 05i9i2022 P W ner/Authorized Agent Signature Date (Revised 1172019)