3205 52ND PL SW 2025-03-24 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EV E R E T T SUBMITTAL 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 0 0. -W4, .liltipiN06 WMA t N /-. - PROJECT ADDRESS: aZ0 S a h S f,J ' Yt?r e-i> Li�e., SITE WORK FOR PROJECT TYPE: ICSFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU []MULTI- IL IAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB#: APR 2 2024 'Si..13 L•\..i /► it FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: m DRIVEWAY APRON/CURB CUT FT WIDE ❑Combined Sewer f�ASPHALT/CONCRETE PAVING q�n/�y a ❑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 ❑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): ITotal/New+Replaced: SF �`/1 C O� " �, �C�G 61 III 4L� t OWNER/APPLICANT NAME: ) OWNER/APP. MAILING ADDRESS: STREET 3 (/ U A 11 �jPj S G ,/ (� CITY vere-H STATE ton, OWNER/APP.PHONE:�f X SJ �� 7 OWNER/APP. EMAIL: d k l Ct, 'Required for Work in Public Right-of-Way Ak CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 3.2.O S— n.c>/ S ev CITY `✓Pre- STATE. ZIP96,J-0 CONTRACTOR PHONE: '/2 L) �?8$ 7 CONTRACTOR EMAIL: Qv (ck ., C CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE VIREQ1 IIRED):- PRIMARY CONTACT: $OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect,Engineer,Etc.) CONTACT NAME: �#'j_ CONTACT PHONE: 14�L--I CONTACT EMAIL: Ale r 'a 1 � ACKNOWLEDGEMENT.'/have reviewed this application and confirm the information contained herein is true and orrect. 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 L_/ PRW �O� - D3 Owner/Authorized Agent ignatur Date (Revised 412112022)