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<br /> Egni PUBUC \' /Li S PE! MOT - PLIC 41 B•N
<br /> CITY OF EVERETT PERMIT SEI I IILS
<br /> �l E ` ' 3200 CEDAR STREET, EVERETT,WA 98201
<br /> �® T
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettvva.govl_https://everettwa.gov/permits
<br /> ;OM.Mglaa:MI _ PROJEC $ITE R,N RMA 1O :cn' ,'... t .31�..":.,,.�. .-. ..e3.' .,r* _n1 ?'s_i
<br /> PROJECT ADDRESS: a( ® kMaim& .Viu Dr # t '? 'o W ///Q,Ir f- t/&i,il A-L ''
<br /> SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU, 1v1ULTI-FA?VIIIY ❑COF))IMI PIAL;;9NDU5TRIAL
<br /> a , � s.
<br /> IF APPLICABLE: 0 LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) (_
<br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS:
<br /> O.FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO:
<br /> ❑ DRIVEWAY APRON/CURB CUT FT WIDE Combined Sewer
<br /> CI ASPHALT/CONCRETE PAVING SF Separated Storm Sewer
<br /> ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY - LF ❑ Direct Discharge to Snohomish River or Puget Sound
<br /> ii RETAINING WALLfROCKERY OVER 4FT IN HFIr;HT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS:
<br /> YI CLEARING/GRADING/FILL/EXCAVATE 4 0ao CY FILL 0 MR2 Only ❑MR1-5 ❑MR1-9
<br /> El CUT/BORE IN PAVEMENT(PARALLEL) _ . QUANTITY OF PROPOSED HARD SURFACES:
<br /> 1 CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: .__ _ SF
<br /> O_
<br /> ❑POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF
<br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: _- - - SF,
<br /> P'a&e ?q// dirt ex eel v 7 ;Im a�a?/ Aid-mom 07► . /r1E. al .Q7--Q0 .4, ,27561
<br /> ___W a. iF 11i Dr. /f oa thj ion f DOD e
<br /> OWNER/APPLICANT NAME: <'/<o 1J7A-L. 5re 0 L L-C,
<br /> OWNER/APP. MAILING ADDRESS: STREET P. 0e0' V < 2 477 / /' �/
<br /> --,,'4 :p,:.-r- STATE Lti) '� ZIP ( 44�,
<br /> CITY �'���r`�•6 >e./.°�/ - -
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<br /> OWNER/APP. PHONE:yS�'�✓G J`-,3 OWNER I APP.EMAIL: A a 7- �(<4,1-`r —4 ,a%t sf--t
<br /> "Required for Work in Public Right-of-Way
<br /> CONTRACTOR NAME: (.(/ v qj K) �,, A J Cr--4 iS 6-6°e,„ W-k
<br /> CONTRACTOR ADDRESS: STREET J.(, '1. 9 dl qT},4 vE-- y ..Az_.,
<br /> CITY
<br /> /4-R L1 toC,-roe,/ STATE I/..J/f ZIPgZ?I".,
<br /> CONTRACTOR PHONE: L1.1_5"-=-4'7 I, -- 6;1—`7 =-- CONTRACTOR EMAIL: ��r ND- 11 (. 6 AO p. gr G -6 Cam`'7
<br /> CONTRACTOR LICENSE#(REQUIRED): 6,©1-f -O BiQ, —q3 C EVERETT BUSINESS LICENSE#(REQUIRED): 6 0 7 a?
<br /> PRIMARY CONTACT: %OWNER/APPLICANT 0 CONTRACTOR 0 OTHER(Architect,xEngineer, Etc.)
<br /> CONTACT NAME: CONTACT PHONE:G/,45 - � "% `2
<br /> A-RI-- ,5i1`�0 t / -L CONTACT EMAIL: -12JT v .`rT' 'i z.-,. e .4;tz,7,';
<br /> ACKNOWLEDGEMENT'I have reviewed this application and confirm the information contained herein is true and 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 /> 1 City of Everett Official Use Only
<br /> a �; PERMIT#
<br /> g ' . ,�� �x. � �,�j/{//� PW 190l7-— 53
<br /> � �f' � .iV ' W'd �.1 a'� 7 Y ,�J y IV O
<br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019)
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