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PUBLIC WORKS PERMIT APPLICATION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https:Heverettwa.gov/permits <br />PROJECT ADDRESS:9530 Holly Dr., Everett, WA 98204 <br />SITE WORK FOR PROJECT TYPE: QSFR-DETACHED OTOWNHOUSE ®DUPLEX []ADU ❑MULTI -FAMILY ❑COMMERCIAL <br />❑INDUSTRIAL <br />IF APPLICABLE: 0 LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) Proposed Short Subdivision <br />IF APPLICABLE: CI FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET <br />PERMIT # <br />UTILITY COMPANY'S NAME & JOB #: <br />JOB # <br />DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />�]✓ FENCE IN ROW <br />DRAINAGE MITIGATION QUESTIONS: <br />FT IN HEIGHT <br />2 DRIVEWAY APRON / CURB CUT <br />STORMWA TER DISCHARGES TO: <br />FT WIDE <br />0 ASPHALT / CONCRETE PAVING <br />❑Combined Sewer <br />SF <br />❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />[✓] Separated Storm Sewer <br />LF <br />❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />❑_ Direct Discharge to Snohomish River or Puget Sound <br />FT TOTAL HEIGHT <br />C✓ CLEARING /GRADING /FILL /EXCAVATE <br />TRIGGERED REQUIREMENTS: <br />Gy <br />❑ GUT/BORE IN PAVEMENT (PARALLEL) <br />0 MR2 Only ❑ MR1_5 ,� MR1-9 <br />LF <br />❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />QUANTITY OF PROPOSED HARD SURFACES: <br />LF <br />❑✓ POLE WORK / AERIAL / OVERLASH <br />Proposed Roof Area: SF <br />LF <br />kDDITIONAL DESCRIPTION (AS NEEDED); <br />Proposed Hardscape: SF <br />Lcw <br />Total New + Replace d: SF <br />`/-j- <br />.ar, c CA <br />- --•-•• -••� ��-••• -•, ,„w .--- ,, ,a., ,, ��, o,,,c� ere,n �s rrue ana correct. Work done pursuant to this permit must <br />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 <br />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 <br />perform the work for which application is made, and I comply with the ,State Contractors Law 18.27 RCW and 296.200A WAC. <br />PERMIT # City of Everett Official Use Only <br />3/30/2022 PW <br />Owner/Authorized Agent Signature Date (Revised 1172019) <br />