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PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL 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:Drew Nielsen Park, Colby Ave& 13th St, Everett, WA 98201 SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: O LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.)Playground equipment replacement IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB#: DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWA TER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer ❑ASPHALT/CONCRETE PAVING SF 8 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: R CLEARING/GRADING/FILL/EXCAVATE 13 CY ❑ MR2 Only ❑ MR1-5 ❑ 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/OVERLASH LF Proposed Hardscape: SF ADDITIONAL DESCRIPTION (AS NEEDED): Total New+Replaced: SF Demo of existing playground equipment and rubber tiles surfacing. Enlarging footprint of playground from 2,711 s ft to 3,227 sq ft. Installation of new playground equipment and Forever Lawn safety surfacing with 3" foam. CONTACT INFORMATION OWNER/APPLICANT NAME:City of Everett Parks Department/Lisa Page OWNER/APP. MAILING ADDRESS: STREET 802 E Mukilteo Blvd CITY Everett STATE WA , 98203 OWNER/APP. PHONE:425-626-3605 OWNER I APP. EMAIL:(page@everettwa.gov `Required for Work in Public Right-of-Way CONTRACTOR NAME: Play Creation CONTRACTOR ADDRESS: ST1EET2104 SW 152nd St, Suite 1 CITY Burien STATE WA ZIP 98166 CONTRACTOR PHONE:206-932-6366 CONTRACTOR EMAIL:Johnl@playcreation.com CONTRACTOR LICENSE#(REQUIRED):LANDSS1973NQ EVERETT BUSINESS LICENSE#(REQUIRED): 44560 PRIMARY CONTACT: 8 OWNER /APPLICANT ❑ CONTRACTOR ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE:425-626-3605 Lisa Page CONTACT EMAIL: (page@everettwa.gov 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. 1 am the owner,or l 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 03/19/2025 PERMIT# Owner/Authorized Agent Signature Date (Revised 412112022)