1332 GRAND AVE 2025-09-26 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS:Email applicatlon&submittal documents to PermAServIGes@everettwa.gov or drop off at 3200 Cedar Street god Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)Perm!tSetvices@everettwa.gov I(W)everettwa.gov/permits -T 6 TEINF 64MAA04Z PROJECT ADDRESS: SITE WORK FOR PROJECT TYPE: LJSFR-DETACHED DTOWNHOUSE IJDUPLEX 13ADU GMLILTI.FAMILY 000MMERCIAL. OINDUSTRIAL IF APPLICABLE: OLAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE' []FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB#: FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: 11 FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: 0 DRIVEWAY APRON I CURB CUT FT WIDE 0 Combined Sewer 11 ASPHALT I CONCRETE PAVING - SF 0 Separated Storm Sewer El RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF [3 Direct Discharge to Snohomish River or Puget Sound 11 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: C1 CLEARING I GRADING I FILL I EXCAVATE —CY 13MR2Only 13MR11-5 13MRI-9 0 CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: El CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF 11 POLE WORK I AERIAL I OVERLASH LF Proposed Hardscapa', SF ADDITIONAL DESCRIPTION(AS NEEDED): ITotal New+Replaced: SF O Vk N OWNER I APPLICANT NAME: OWNER/APP. MAILING ADDRESS: STREET Ar a it CITY 61 STATE ZIP OWNER/APP.PHONE: OWNER I AP P.EMAIL: 'Required for Work in Public Right-of-Way CONTRACTOR NAME: A CONTRACTOR ADDRESS, S/REET CITY STATE, ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR,LICENSE"#(,R I E-QUI,RE D)I IEVERETT BUSINESS LICENSE#(REQUIRED):.. PRIMARY CONTACT- )09WNER /APPLICANT DCONTRACTOR OOTHER(Architect, Engineer,Etc.)_ 0ONrT ME: CONTACT PHONE: -51 CONTACT EMAIL- 4 A i-f iL e1VI d D e t, f ti ACKNOWLEDGEMENT.,I have reviewed this application and confirm the information conta#d heroin Is true and correct. Work on ursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no do fin Q therefrom.Deviations must first be 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 perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. CJtYo1 Everett Official Use Only ERMIT PW I Owner/Authorized Agent Signature Date (Revised 412112022)