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PUBLIC WORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 <br /> wASNI NO,TON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everettepsl@everettwa.gov I https://everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Zak u <br /> SITE WORK FOR PROJECT TYPE: rR-DETACHED LITOWNHOUSE []DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL <br /> IF APPLICABLE: U LAND USE PROJECT#(,-,EPA,PRE-APP, SS, ETC.) <br /> IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# <br /> UTILITY COMPANY'S NAME&JOB#: JOB# <br /> DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> KA' 1 FENCE IN ROW � FT IN HEIGHT STORMWATER DI•SCHAP,GES TO: <br /> ,- �t <br /> DRIVEWAY APRON'CURB CUT FT WIDE ❑Combined Sewer <br /> ASPHALT t CONCRETE PAVING SF ❑Separated Storm Sewer <br /> ]RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound <br /> 1 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUfREtAENTS: <br /> CLEARING/GRADING I FILL I EXCAVATE CY ❑ MR2 Only ❑MR1-5 ❑ MR1-9 <br /> CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> ]CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF <br /> 1 POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New*Replaced: SF <br />)i <br /> CONTACT INFORMATION <br />• DWNER APPLICANT NAME: V ell 117) <br /> i <br /> OWNER;APP. MAILING ADDRESS: STREET <br /> aTY V Q�( STATE <br /> OWNER I APP. PHONE: y2-S-�J�2' OWNER I APP.EMAIL: ►1 M, 1,u C3 <br />�!! Zey�ire fOt!lore.rn Public Right-of2A(ay �, <br />,t CONTRACTOR NAME: SOS ( <br /> I UVt O\AAQ b�`I \�11alo <br /> CONTRACTOR ADDRESS: C< STRUT <br /> CITY 4-)V)0�nOm I Vsb rSTATE�,N _1F 2•" <br /> CONTRACTOR PHONE: 'l Z�J - 3� 1 - s�o CONTRACTOR EMAIL: -��ti\�JO��I t chU•\ LJ C����1 <br /> CONTRACTOR LICENSE#(kF0U1RF0): LAMI"BFC��, 2 �'�1 EVERETT BUSINESS LICENSE#(REQUIRED): (.piA 2 <br /> PRIMARY CONTACT: S)VVNFR /APPLICANT n GONTRACTOR OTH-R(Architect,Engineer,Etc.) <br /> F CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL.: G Amcm I <br /> t ACK140WIFLGf M1-NI,I havu ruvlewud(/its app6ca110,0 m,u cunbun Ulu t,do,nurhun IS Uuu anal aa,vuf sua to this permit must <br /> is Comply with current federal,state,and local law. The(/tunlan0(it a peanut unly aulhotlzes apptuved work and no deviations theretiurn.Deviations must first be <br /> authorized in writing from tho Building Official butoru bunny authorizod under any circumstanco.I am the owner,or I am authorized by the owner of this property to <br /> perform the work for which apfiltr,abori tS tna(lu,and I comply wilt)the Stale Curttiticturs Law 18.17 Nt.;W and 29(i.200A WAC. <br /> City of Everett Official Use Only <br /> ' L PERMIT# <br /> PW <br /> Owner/Authorized Agont Sig ure Oat (hevisad 1;72019) <br />