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PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 41 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https-,//everettwa.gov/permits PROJECT ADDRESS: 2 I / 5 / _V� SITE WORK FOR PROJECT TYPE: ®SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX CIADU ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ®LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # UTILITY COMPANY'S NAME & JOB M JOB # IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE (.ASPHALT / CONCRETE PAVING 52- SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT ❑ CLEARING / GRADING I FILL / EXCAVATE ❑ CUTBORE IN PAVEMENT (PARALLEL) ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) ❑ POLE WORK / AERIAL / OVERLASH ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: ❑ Combined Sewer Separated Storm Sewer Direct Discharge to Snohomish River or Puget Sound FT TOTAL HEIGHT (TRIGGERED REQUIREMENTS: CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 LF QUANTITY OF PROPOSED HARD SURFACES: LF Proposed Roof Area: SF LF Proposed Hardscape: SF Total New + Replaced: SF 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 t comply with the State Contractors Law 18.27 RCW and 298.200A WAC. City of Everett Official Use Only PERMIT # 04 /� zoo IPW 4 2ri.dAuthd4zed-Anen Slgnature Date (Revised 1172019)