4326 CRESCENT AVE 2025-06-30 - 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:4326 Crescent Ave Everett WA 98203 Permit # PW2103-018 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.)SS20-004 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: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT FT WIDE ❑ ASPHALT / CONCRETE PAVING SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT ❑ CLEARING / GRADING / FILL / EXCAVATE CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK / AERIAL / OVERLASH LF ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWA TER DISCHARGES TO: ❑ Combined Sewer ❑ Separated Storm Sewer ❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF ITotal New+ Replaced: SF utilities for a 3 lot shortplat Permit # PW2103-018 CONTACT INFORMATION OWNER / APPLICANT NAME:AMA Ventures LLC OWNER / APP. MAILING ADDRESS: STREETPO Box 1395 c,n Lake Stevens STATE WA z,P 98258 OWNER / APP. PHONE:4255082465 OWNER I APP. EMAIL: pavelgpa@gmail.Com `Required for Work in Public Right -of -Way CONTRACTOR NAME: GPA Enterprises Inc CONTRACTOR ADDRESS: STREETPO Box 271 CITY Lake Stevens STATE WA z,P 98258 CONTRACTOR PHONE:4255082465 ICONTRACTOR EMAIL:pavelgpa@gmall.com CONTRACTOR LICENSE #(REQUIRED):GPAENEI853D5 1EVERETT BUSINESS LICENSE#(REQUIRED): 62284 PRIMARY CONTACT: ❑ OWNER / APPLICANT @ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Pavel An d reya n ov CONTACT PHONE:4255082465 CONTACT EMAIL: Pavel 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 I 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. Pavel Andreyanov 3/23/23 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # PW (Revised 412112022)