4030 RUCKER AVE 2025-11-04 - Laserfiche WebLink

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:4030 RUCKER AVENUE, EVERETT, WASHINGTON SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY RCOMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑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 STORMWA TER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer @ ASPHALT/CONCRETE PAVING 2' X 2' 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 ❑ 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 Drilling through pavement for installation of monitoring wells (MW-16, MW-17, and MW-19) in right-of-way. CONTACT INFORMATION OWNER I APPLICANT NAME:Arcadls U.S., Inc. OWNER/APP. MAILING ADDRESS: STREET 11 00 OI ive Way CITY Seattle STATE WA Z,P 98101 OWNER/APP. PHONE:773.817.3883 1OWNER/APP. EMAIL:jenny.liu@arcadls.com `Required for Work in Public Right-of-Way CONTRACTOR NAME: Cascade Environmental Drilling CONTRACTOR ADDRESS: ST1EET19404 Woodinville Snohomish Road NE QC C QITY Q Woodinville STATE WA ZIP 98072 CONTRACTOR PHONE:425.466.8588 1CONTRACTOR EMAIL:kgobel@cascade-env.com CONTRACTOR LICENSE#(REQUIRED):CASCADL9150H IEVERETT BUSINESS LICENSE#(REQUIRED): 47889 PRIMARY CONTACT: ❑ OWNER /APPLICANT ❑ CONTRACTOR R OTHER(Architect, Engineer, Etc.) Environmental Engineer(Arcadis) CONTACT NAME: Jenny Liu I CONTACT PHONE:773.8 1 7.3883 CONTACT EMAIL:Jenny.11u@arCadis.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 Jenny Liu 01/23/2023 PERMIT# Owner/Authorized Agent Signature Date (Revised 412112022)