4030 RUCKER AVE 2025-11-04 - Laserfiche WebLink

EVERETT PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON V-14Z0-Z4r-t3t11U I FAX 425-257-8857 i (E) everetteps@everetlwa.gov i https://everettwa.gowpermits PROJECT SITE INFORMATION PROJECT ADDRESS:4030 Rucker Ave. Everett WA 98201 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑✓ COMMERCIAL DINDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB M JOB # DESCRIPTION OF SITE WORK I 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 35 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_ ❑ MRIS ❑ MRt-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 Looking to re -open drive way and needed landscapinq CONTACT INFORMATION OWNER / APPLICANT NAME: Mena Flemon OWNER/APP. MAILING ADDRESS: sTREEr14023 Znd ave. W. airy Everett STATE WA zip 98208 OWNER /APP. PHONE:(206)851-2720 1OWNERIAPP. EMAIL: menaflemon@hotmall.Com *Required for work m Public Rlght-of-Way CONTRACTOR NAME: CONTRACTOR ADDRESS: STfiEEr CRY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ❑✓ OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Mena Flemon CONTACTPHONE: (206)851-2720 CONTACT EMAIL:menagemon@hotmail.com ACKNOWLEDGEMENT (have reviewed this application and confirm the information contained herein is true and correct Work done pursuan o rs perm) must comply with currant federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in wnhng from the building Official before being authorized under any amumstance. I am the owner, or 1 am authorized by the owner o/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 Official Use Onl /Zo 2 z Agent slgnnure CIryolEverett Iua y PERMIT # PW (Revised 1/72019)