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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMRTAL INSTRUCTION Email applkaRn S womber warrants We or drtp c11 at 3200 WANT Strew 2nd Fear Drop So <br />WAUHHNGTON CONTACT INFORMATIOM (P) 425 25T 88101(E) PermuServlces@averamea.gw I lW)evmetlxa.pw/Pormlls <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 100321 led Place W <br />SITE WORK FOR PROJECT TYPE: NSFR-DETACHED OTOWNHOUSE ODUPI rx OAOV OMW TI-FAMILY 000MMERCIAL CLNDUSTRIAL <br />IF APPLICABLE: 0 )AND USE PROJECT 9 (SERA, PRE ARE, SS. ETC.) CE24-0407 <br />IFAPPLICABLE: E21FRANCHISENTILITY COMPANY, ANNUAL BLANKET PERMIT <br />UTILITY COMPANY'S NAME B JOB AP JOB C: <br />DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE <br />❑ FENCE IN ROW FT IN HEIGHT <br />❑ DRIVEWAY APRON I CURB CUT FT WIDE <br />O ASPHALT I CONCRETE PAVING SF <br />❑ RETAINING WALL I ROCKERY IN RIGHT-0E-WAY LF <br />❑ RETAINING WALL I ROCKERY OVER JET IN HEIGHT FT TOTAL HEIGHT <br />OO CLEARING) GRADING) FILL I EXCAVATE 1,936SF 10 Cy <br />❑ CUTI IN PAVEMENT( PARALLEL) LF <br />❑ CUUBORE IN PAVEMENT( NON -PARALLEL) LF <br />❑ POLE WORK I AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDED): <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OOomblral Sawer <br />O SeperaNd Slone Sever <br />■ Dimd Discharge to SuaMmieb River or Puget Sound <br />TRIGGEREDREQUIREMENTS: <br />(IMBOOnly ■MRPS OMI <br />QUANPTY OF PROPOSED HARD SURFACES: <br />Proposed Roof Area O SF <br />Proposed Handsome: O BE <br />Total New Replaced. 0 SF <br />1,26 s uare <br />feet of <br />trees were removed from Wetland A and will be restored to re -disturbance <br />conditions by <br />installing <br />native trees and shrubs at a 1:1 <br />ratio. <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME: Jetlie A. Weeden-Ishman <br />OWNER IAPP. MAILING ADDRESS ear 10032191h Place <br />Everett ATATE WA zip N204 <br />OWNER IMP. PHONE:(206) 650-7150 <br />OWNER I APP. EMAIL aaweedenishman@lrontier.com <br />'Required for Work In Public Righto! Way <br />CONTRACTOR NAME: NIA. No work proposed in ROW <br />CONTRACTOR ADDRESS: <br />any STAM <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: - <br />CONTRACTOR LICENSE N(REOUIRED):' <br />EVERETT BUSINESS LICENSE #(REQUIRED): - <br />PRIMARY CONTACT: ❑ OWNER IAPPLICANT ❑ CONTRACTOR IN OTHER (Arohltect, Engineer, Etc.) wi <br />CONTACT NAME: <br />Alex Wachter, Wetland Resources, Inc. <br />CONTACT PHONE: 41111111 TO <br />CONTACT EMAIL alNameuaeva,v.mn <br />ACKNOWLEDGEMENT I here mviewed this apdrcafien and corri the infonrlation com aimO M1erem is true and wnxl. Work doaw pxsuanl to Mix jamet may <br />widely with current h l,state, and Goal law. Tee gaming&a permit cne}xe endows Approved parr ark no dewatlans theramorm. Lawmaker meet fire be <br />aNlMmdInork fo wh IFSBulldmg is mori and being sNlMmtlemde Contractors <br />La 1IamO dead ap am arRM1ordetl by Me ownardlM1ispmpaty to <br />parbrm Ilre work for Much application is neade, andl comply water 0e State Confredom' Law 182]RCW eM 268.10gA WAC. <br />Cry, of Capped OMnel Use QMy <br />FEKMI <br />PW <br />Owneralthorized Agent Signature Date (ReWed MLifJ022J <br />