10024 19TH PL W 2026-04-13 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMmK INSTRUCTION : Email xpnikeRn S womber documents PermM1servlw¢($ee'renlMa.go, or drtp all at 320n Order strain and Bad Drop WASHPINGTON CONTACT INFONMATION. E) 425 25T 88101(E) Permll5ervlces@avaralMa.gw l BY)evmetlxa.pw/Pormils ISCT SITE INFORMATION PROJECT ADDRESS: 1002419th Place W SITE WORK FOR PROJECT TYPE: BSFR-DETACHED OTOWNHOUSE ❑DUPIEx MAOU OMUIL FAMILY OCOMMERCIAL OINDUSTRIAL IF APPLICABLE: O )AND USE PROJECT k (SERA, PRE ARE, SS. ETC.) CE24-0406 IFAPPLIOABLE: QFRANCHISENTILITY COMPANY, ANNUAL BLANKET PERMIT UTILITY COMPANY'S NAME a JOB It: JOB k: DESCRIPTION OF SI FILL IN ALL QUANTITIES OF WORK BELOW AS APPLICABLE: ❑ FENCE IN ROW FT IN HEIGHT ❑ DRIVEWAY APRON I CURB CUT FTWIDE O ASPHALT I CONCRETE PAVING SF ❑ RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF ❑ RETAINING WALL I ROCKERY OVER JET IN HEIGHT FT TOTAL HEIGHT ■ CLEARING) GRADING) FILLI EXCAVATE 1,100 SF OY O CUTWRE IN PAVEMENT( PARALLEL) LF O CU UBORE IN PAVEMENT (NON -PARALLEL) LF ❑ POLE WORK I AERIAL I OVERLASH LF ADDITIONAL DESCRIPTION AS NEEDED): F-WAY WORK DRAINAGE MITIGATION QUESTIONS: STORMWATER DISCHARGES TO: Dcombined Bewar O separatad Manor Sever ■ Direct Diealarpe to Sarromisb River or Puget Sound TRIGGERED REQUIREMENTS: EIMR40nly OMR1-5 DUBUC QUANTITY OF PROPOSED HARD SURFACES: Proposed RMAAwdr O SF Pro{ared Handsome: 0 BE Total Nary a Replaced 0 BE A roximatel 1 100 s uare feet Of trees were removed from a wetland. Native trees will be installed within the wetland at a 1:1 ratio. CONTACT INFORMATION OWNER I APPLICANT NAME: ROI)ert E111ng $ Alm" ECOIango OWNER IAPP. MAILING ADDRESS: SIREU10024191h Place W n Everett ATATC WA ZIP 98204 OWNER IMP. PHONE:(206) 914-5365 OWNER I APP. EMAIL: RObbetlmg@gmall.Dom 'Required for Work In Public Righto! Way CONTRACTOR NAME: N/A, NO wort( proposed In ROW CONTRACTOR ADDRESS: CONTRACTOR PHONE:- CONTRACTOREMAIL:- CONTRACTOR LICENSE N(REDUIREm: - EVERETT BUSINESS LICENSE #(REQUIRED): - PRIMARYCONTACT: ❑ OWNER I APPLICANT ❑CONTRACTOR 0OTHER (ArchIIeCL Engineer, Etc.) example CONTACT NAME: Alex WaCMer. Wellantl Resources, Inc. CONTACT PHONE 1425)337-3174 CONTACT EMNL:alex@wegantlremumes.com ACKNOWLEDGEMENT I have reWmwtl this appLiafien amid confirm Me iMonextion mn aimd hi is Tom aM wool. Work Mow pxsoanlro M s Pordat mlut sump/y MIh murrrked Amoco' elater and di lawme gran ding an parmil any audempas approved nwk aW no dawatlens enere/mm. DewalMe mwt nrACar aNlMmd M mil4lp hen Me Butldmg Ofti bNore being AMdAwd undsomy choumslanaa. I am the owner, al am arranged by Me owner dthis pmpsty to random fire emak for Much epir cefimn is Cade, and I comply w4h the State Conhedors Law 1827 RCW and 2g OMA MAC. On, of EueneH OMnal Use QMy FEKMI PW OwneMAulhorizad Agent Signature Dine ffowarfMLU2022)