4409 30TH DR SE 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-OAxamilwamy or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-881 (E)PermitServices@everettwa.go,I(W)everettwa.gov/permits PROJECT SITE.INFORMATION KPROJECT ADDRESS: U C, vc (,,� C -G' SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB M DESCRIPTION OF`SITE WORK'/ RIGHT-&'-WAY WORK - FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑ DRIVEWAY APRON I CURB C,UT i FT WIDE ❑Combined Sewer ASPHALT/CONCRETE�pAVNG y1 _reAk-4 so4ll 3 2- - SF!?_%AkA. ❑Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑ CLEARING/GRADING/FILL/EXCAVATE CY ❑MR2 Only ❑ MRi-5 ❑MR1-9 ❑CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES. ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF ❑ POLE WORK/AERIAL I OVERLASH LF Proposed Hardscape: SF V ADDITIONAL DESCRIPTION(AS NEEDED): ITotal New+Replaced: SF "L Ll� A�,Lek, b"W ft�, 21 LA,A4r2re A, Nz V CONTACT,INFORMATION OWNER/APPLICANT NAME: ` Z OWNER/APP. MAILING ADDRESS: STREET 1, �SE- CITY _ / STATE I.VI ZIP t OWNER/APP. PHONE: 2,) 215-5 33 5 IOWN' ERIAPP. EMAIL: P 'Required for Work in Public Right-of-Way CONTRACTOR NAME: (,,,J CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): j PRIMARY CONTACT: OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER(Architect,Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 25 21 31-)c �v�� o�l�Z-� CONTACT EMAIL: © C ,� ACKNOWLEDGEMENT:1 have reviewed this application and confirm the Information contained beret is tr 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application Is made,and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <6 `zb2 PW 2,,, -0 � Z Owner/Authorized Agent Sign ture Date (Revised 412112022)