4030 COLBY AVE 2025-07-18 - Laserfiche WebLink

PUBLIC WORKS PERMIT Ar PLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT. WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteos0everettwa_nnv Ihttns'//P\/PrPthe/P nn,//nP.mi4c PROJECT SITE INFORMATION PROJECT ADDRESS:4030 Colby Ave (adj. parcel #: 00582101101700) SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE []DUPLEX ❑ADU []MULTI -FAMILY ZCOMMERCIAL ❑INDUSTRIAL IF APPLICABLE: © LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) Review Process If Application (submitted separately) IF APPLICABLE: Z FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT # (On -File) UTILITY COMPANY'S NAME & JOB #: New Cingularwreiess PCS, LLC CAT&' JOB # 17726-004-B 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 Z POLE WORK / AERIAL / OVERLASH Light Pole Replacement 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 Total New+ Replaced: SF AT&T 17726-004-B: Proposed Small Wireless Facility (SWF) Node attachment to new utility liqht pole, including new foundation, specificaliv designed for AT&T's SWF in place of an existinq utilitv light pole. All Fiber and Power permittinq provided by others. CONTACT INFORMATION OWNER / APPLICANT NAME: New Cingular Wireless PCs, LLC (d/b/a AT&T Mobility LLC) / Nicholas Zachary Nittolo OWNER/APP. MAILING ADDRESS: sT,,,u 16331 NE 72nd Way cnr Redmond STATE WA ZIP 98052 OWNER / APP. PHONE: (425) 499-8262 1OWNERIAPP. EMAIL: nn414j@us.att.com 'Required for Work in Public Right -of -Way CONTRACTOR NAME: MaSTec Network Solutions CONTRACTOR ADDRESS: s,REET22263 68th Ave S cnv Kent STATE WA ZIP 98032 CONTRACTOR PHONE: 206-499-1359 1CONTRACTOR EMAIL: &teven.Evenson@mastee.Com CONTRACTOR LICENSE #(REQUIRED): CC MASTENS876KN IEVERETT BUSINESS LICENSE #(REQUIRED): 054443 PRIMARY CONTACT: ❑ OWNER / APPLICANT Z CONTRACTOR Z OTHER (Architect, Engineer, Etc.) Zoning & Planning Manager CONTACT NAME: Gibran Hashmi ICONTACT CONTACT PHONE: (206) 372-1850 EMAIL:gibran.hashmi@mastec.com AGr,N V WLtu(itMGV 1: 1 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 cimumstance. I am the owner, or / 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 296.2004 WAC. City of Everett Official Use Only PERMIT #1 a /� �IGiZB 2CoCiGC1�1 N/ 6Qfl 8/15/19 PW ` \VS _03q Owner/Authorized Went Signatu Date (Revised 1172019)