1410 SEINER DR FISHERMAN JACKS 2025-08-21

PUBLIC WORKS PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I https:Heverettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: Parcel A8; 1410 Seiner Drive SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY ✓❑COMMERCIAL []INDUSTRIAL IF APPLICABLE: Ll LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) EPPLICABLE: ElFRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME & JOB M JOB # DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: ❑ FENCE IN ROW 0 FT IN HEIGHT ❑ DRIVEWAY APRON / CURB CUT 0 FT WIDE ❑ ASPHALT / CONCRETE PAVING 0 SF ❑ RETAINING WALL / ROCKERY IN RIGHT-OF-WAY 0 LF ❑ RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT 0 FT TOTAL HEIGHT s❑ CLEARING / GRADING / FILL / EXCAVATE 1460 CY ❑ CUT/BORE IN PAVEMENT (PARALLEL) 0 LF ❑ CUT/BORE IN PAVEMENT (NON -PARALLEL) 0 LF ❑ POLE WORK / AERIAL / OVERLASH 0 LF ADDITIONAL DESCRIPTION (AS NEEDED): DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: ❑ Combined Sewer ❑ Separated Storm Sewer s❑ Direct Discharge to Snohomish River or Puget Sound TRIGGERED REQUIREMENTS: ❑ MR2 Only ❑ MR1-5 s❑ MR1-9 QUANTITY OF PROPOSED HARD SURFACES: Proposed Roof Area: SF Proposed Hardscape: SF ITotal New+ Replaced: SF Proiect includes the followinq elements: 1) Early clearinq, grubbing, and gradinq the site to the correct elevation: 2) Performinq the qeotechnical subgrade qround improvement rigid inclusions on site. CONTACT INFORMATION OWNER / APPLICANT NAME: Port of Everett OWNER/APP. MAILING ADDRESS: STREET 1205 Craftsman Way, Suite 200 CITY Everett STATE • •' ` Zlp 98201 OWNER / APP. PHONE: 425-259-3164 1OWNER / APP. EMAIL: `Required for Work in Public Right -of -Way CONTRACTOR NAME: This specific work will not be conducted in public right-of-way. CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): I EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: F11 OWNER / APPLICANT ❑ CONTRACTOR ❑ OTHER (Architect, Engineer, Etc.) CONTACT NAME: Brandon Whitaker CONTACT PHONE: 425-508-56627 CONTACT EMAIL: bwhitaker@portofeverett.com 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. October 20, 2021 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # PW (Revised 1172019)