10016 19TH PL W 2026-04-13 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTeUBMRTAL INSTRUCTION : Email xpplkeRn S womber candidate PermM1Bervlw¢($ee'rendwa.go, or Ertp all at 3200 order 9heN and Bad Drop WASHPINGTON CONTACT INFONMATION. E) 425 25T 88101(E) Permll5ervlces@avaralMa.gw l lw)evmetlxa.pw/Pormils P CT SITE INFORMATION PROJECT ADDRESS: 1001619th Place W SITE WORK FOR PROJECT TYPE: 13SFR-DUAOHED OTOWNHOUSE ❑DUPIFx MAOU OMUIL FAMILY IJCOMMERCIAL OINDUSTRIAL IF APPLICABLE: O )AND USE PROJECT k (SERA, PRE ARE, SS. ETC.) CE24-0405 IFAPPLIOABLE: QFRANCHISENTILITY COMPANY, ANNUAL BLANKET PERMIT UTILITY COMPANY'S NAME a JOB IF 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 3 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: 0combined swear O sePoranad slum swrer ■ Direct Distllarpe to Sralnmisb River or Finger Sound TRIGGERED REQUIREMENTS: E' MBOOnly QMR1-5 [31 1A QUANTITY OF PROPOSED HARD SURFACES: Proposed RMAAMM O SF Proposed Handsome: 0 SF Tonal Nary a Replaced 0 BE An 85 s uare toot landsea in pond was installed within a all established lawn area between 2002 and 2005. The pond is preposed to remain in its current condition. CONTACT INFORMATION OWNER I APPLICANT NAME: David AmSton OWNER I APP. MAILING ADDRESS: mili6191h Place TY Everett n,E WA 98204 OWNER IMP. PHONE:(206) 9159707 IOWNER I APP. EMAIL darnStOnL@gmall.com 'Required for Work In Public Righto! Way CONTRACTOR NAME: N/A, NO work proposed In ROW CONTRACTOR ADDRESS: amadi STAM CONTRACTOR PHONE:- CONTRACTOREMAIL:- CONTRACTOR LICENSE N(REDUIRED): - EVERETT BUSINESS LICENSE #(REQUIRED): - PRIMARYCONTACT: ❑ OWNER I APPLICANT ❑CONTRACTOR iOTHER (ArchIIeCL Engineer, Etc.) Ecologist CONTACT NAME: Alex WaCMer. Welland Resources, Inc. CONTACT PHONE i4251337-3114 CONTACT EMAIL:alex@wegantlresoumes.com ACKNOWLEDGEMENT I have reWmwtl this appLiafien amid confirm Me iMonextiom mmhimd hi is hum and wmLi. Work Mow pxsuantro M s Pordat mlut comply wear mlpmd newel, ante, and ucai lawOn granting an a pemif any auuradaas approved wank ared no dawarwrs Specs en, Dewalmns mwt nrnm aNlMmd M mil4lp hen Ma Bulldmg OMcial before being 9WlM boundary cvrtumslanro.Iamthe, owner, a lam arranged by Me owner dthis toward, to random fire work for Much appVanfibn is Cade, and I comply wank the Stale Conhnstors Law 1827 RCW and 2g OMA MAC. Cly o/0"1 OMnnl Use QMy FEKMI PW OwneuAuthorizad Agent Signature Date (ReWnf MlifJ022)