1722 100TH ST SW 2025-11-07 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:Email application&submittal documents to PermitServices@everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION ' PROJECT ADDRESS: "I E—rL `( W A .D 6F/t1'Cl L O ) p yj U 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#: DESCRIPTION OF SITE WORK4 RIGHT-OF-WAY WORK.' FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: 0 FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO. I�DRIVEWAY APRON I CURB CUT 30 FT WIDE ❑Combined Sewer r �Q ASPHALT/CONCRETE PAVING I 'i SF fj Separated Storm Sewer ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound _ ❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS. 0 CLEARING I GRADING I FILL I EXCAVATE I5 CY ❑MR2 Only JAM R1-5 ❑MR1-9 ❑ CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES. ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: 3 , t-I-2-0 SF ❑ POLE WORK I AERIAL I OVERLASH LF Proposed Hardscape:- ( ,�5 SF ^ADDITIONAL DESCRIPTION(AS NEEDED):I S , ` Total New+Replaced: 1:k (j5 SF y 6Uf 2.b CONTACT INFORMATION OWNER/APPLICANT NAME: LRj L(� OWNER/APP. MAILING ADDRESS: srrtEEr (� 2,11 - Cm` STATE ZIP OWNER/APP.PHONE: 4 f •08— c. 0OWNER/APP.EMAIL: M) -OP e ,*Required for Work in Public Right-of-Way CONTRACTOR NAME: 6 VA CONTRACTOR ADDRESS: 8TREET clrY N F ST'�IrhlS STATE In)A zIP9EZ�p CONTRACTOR PHONE: 2S 50 2`'I to CONTRACTOR EMAIL: AtfE1�l�pJ� �( n1l91 j CONTRACTOR LICENSE#(REQUIRED): (�� g(y r7'317� EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER /APPLICANT ❑CONTRACTOR 'OTHER(Architect,Engineer, Etc.) Z CONTACT NAME: CONTACT PHONE: 3{00 SZ- Egg -6-pem M CAM' _E. CONTACT EMAIL: MAC �tv� III) I N (& M_rj ,( 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.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. City of Everett Official Use Only PERMIT it n� I'3012-2 PW Z Zoe 0 2,4- Owner/_ Autltq tzed Agent Signature Dafe (Revised 412112022)