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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMmK INSTRUCTIONS: Email implication S werniMl documents We or drtp all at 3200 BEES Sheet 2nd Fear Drop So <br />WASHPINGTON CONTACT INFORMATIOM(P)42525T 88101(E) PermuServlces@averarthe w llw)evmetlxa.pw/Pormlls <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 100241 Rh Place W <br />SITE WORK FOR PROJECT TYPE: NSFR-DETACHED OTOWNHOUSE ODUPI rat OAOV OMW TI-FAMILY OCOMMERCIAL OINDUSTRIAL <br />IF APPLICABLE: 0 )AND USE PROJECT 9 (SERA, PRE ARE, S5. ETC.) CE24.0406 <br />IFAPPLICABLE: E2FRANCHISENTILITY COMPANY, ANNUAL BLANKET PERMIT <br />UTILITY COMPANY'S NAME a JOB Ih 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 1.1005E CY <br />❑ CUTWRE IN PAVEMENT (PARALLEL) LF <br />O CUUBORE IN PAVEMENT( NON -PARALLEL) LF <br />❑ POLE WORK I AERIAL I OVERLASH LF <br />ADDITIONAL DESCRIPTION (AS NEEDEO): <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OOombined Seater <br />O BeparaMd Stan Sever <br />■ Dired Discharge to Smomish River or Puget Sound <br />TRIGGEREDREQUIREMENTS: <br />OMe2only [3MRP5 QMRU9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />Propdae Rom Area: O SF <br />Propmed Handsome: 0 BE <br />Tmal New • Replaced. 0 SF <br />Approximately 1,100 square feet of trees Were removed from a wetland. Native trees and Shrubs will be installed <br />wit In a wet an at a ratio. <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME: Robert Elling A Aimce Ecolangq <br />OWNER I APP. MAILING ADDRESS: err 10024 191h Place <br />Everett ATATE WA zip N204 <br />OWNER IMP. PHONE:(206) 910-5365 <br />OWNERI"P. EMAIL: ROCISting@gmail count <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 INREOUIREm:' <br />EVERETT BUSINESS LICENSE a(REQUIRES: - <br />PRIMARYCONTACT: ❑ OWNER I APPLICANT ❑CONTRACTOR IN OTHER (Architect, Engineer. Etc.) r'"lapn <br />OONTACT NAME: <br />Alex Wachter, Wetland Reeources, Inc. <br />CONTACT PHONE: 41111111 TO <br />CONTACT EMAIL alNameuaeewv.mn <br />ACKNOWLEDGEMENT I here mviewed this apProm on and corri the iaborlation mn am d M1eram is hue ark cement. I/I dame pxsuanl to Ads Porrrnt must <br />mmply MlM1 current h l.ande.and Goal law. Tee Counting& a pamnl mry Americans Approved atvdr ark no devietlans rammudn. Downtown meet fire Ce <br />eNlMmdInmak fo Sharon <br />re Building Onome, and being aNlMmtlemde Confcvrtumslaw 18. <br />ROW <br />am WACrdetl by Me ownardlM1ispropa'ly to <br />parbrm Nre ucrk for Mucb eppYcefion is neade, andl comply water 0e State Conhedom' Law 182]RCW eM 266.100A WAC. <br />Gry o/EuereH DMnel Use QMy <br />FEKMI <br />PW <br />OwnarlAuthorized Agent Signature Dore (ReGRNM2UJg22) <br />