118 PL SE AT 10TH DR SE 2025-01-30

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)PermitServices@everettwa.gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:1 18th Place SE at 10th Drive SE SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.)N/A, District capital project IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT#N/A UTILITY COMPANY'S NAME&JOB#: Silver Lake WSD JOB#: 22-0003 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: ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 8 CUT/BORE IN PAVEMENT(PARALLEL) 20 LF QUANTITY OF PROPOSED HARD SURFACES: 8 CUT/BORE IN PAVEMENT(NON-PARALLEL) 20 LF Proposed Roof Area: SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION (AS NEEDED): ITotal New+Replaced: SF Pavement cut to connect new 12-inch water main in 10th Drive SE to existing District water main in 118th PI SE. Proposal is also to abandon existing 6-inch cast iron water main in place, need input if this is acceptable to COE. See clitt0ched plans. CONTACT INFORMATION OWNER/APPLICANT NAME:Silver Lake Water & Sewer District OWNER/APP. MAILING ADDRESS: STREET 15205 41 st Ave SE CITY Bothell STATE WA Zip 98012 OWNER/APP. PHONE:4255-659-2302 OWNER/APP. EMAIL:ssmith@slwsd.com `Required for Work in Public Right-of-Way CONTRACTOR NAME: TBD, bidding for construction in early 2024 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 8 OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME:Scott Smith CONTACT PHONE:425-659-2302 CONTACT EMAIL:ssmith@slwsd.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. 1 am the owner,or l 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 Scott Smith 12/07/23IPW PERMIT # Owner/Authorized Agent Signature Date (Revised 412112022)