1724 100TH ST SW 2025-11-07 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EV E R E T T SUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitServices@everetlwa.gov or drop off al 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PerrrritServices@everettwa-gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION ., PROJECT ADDRESS: r(� 5kNj - j 1,\J A 9P SITE WORK FOR PROJECT TYPE: SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.)_ "f 22 iF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB M JOB##: DESCRI PTI;W OF SITE WORK1 RIGHT=OF-WAY WORK =ILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: 11 FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: [�DRIVEWAY APRON/CURB CUT FT WIDE ❑Combined Sewer r ASPHALT/CONCRETE PAVING SF Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF 13 Direct Discharge to Snohomish River or Puget Sound ❑RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL.HEIGHT TRIGGERED REQUIREMENTS: A CLEARING I GRADING I FILL/EXCAVATE j 3 n CY ❑MR2 Only JR MR1-5 ❑MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSEDH,AR D SURFACES: ElCUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: !n(f o `gF C1 POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:___ (9 y 5 __SF ADDITIONAL DESCRIPTION(AS NEEDED): ITotal New+Replaced: 390 5 SF CONTACT INFORMATION. JWNER I APPLICANT NAME: - NA \I )WNER I APP. MAILING ADDRESS: STREET ,ter. CITY I,ii1� S V STATE `� ZIPr�' lWNER I APP,PHONE: 4 5— 'o , (o9 OWNER I APP.EMAIL: Required for Work in Public Right-of-Way ON TRACTOR NAME. 63 PA (! S :ONTRACTOR ADDRESS: STREET {�.U. 0'X 7 fir{ c q CITY -C(�`f��I�GJ STATE W A ZfP9G'G�JCJ :ONTRACTOR PHONE: ZS_S Ct�j `2`�to CONTRACTOR EMAIL: "ONTRACTOR LICENSE#(REQUIRED): 31)r EVERETT BUSINESS LICENSE#(REQUIRED): `RIMARY CONTACT. ❑OWNER I APPLICANT ❑CONTRACTOR OTHER(Architect,Engineer,Etc.) - Z :ONTACT NAME: CONTACT PHONE:Mr (/11A,. _E- ICONTACT EMAIL: �{I�1-SIN r -6?l�I • U-1-f CKNOWLEDGEMENT.,t have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must -Imply with current federal,state,and local law. The granting of a permit only authodzes approved work and no deviations therefrom.Deviations must first be ❑thorized 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 grform the work for which application is made,and I comply with the State Contractors Law 16.27 RCW and 288.200A WAG. City of Everett Ofrciat Use Only PERMIT I.30 2 2 PIN vnerl Auth ized Agent Signature Da e t (Revised 412112022)