7430 EVERGREEN WAY 2026-04-06 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS:Emall application&submittal documents to PermilServices@everettwa.gov or drop off at 3200 Cedar Street 2nd Floor Drop Box WASHINGTON CONTACT INFORMATION:(P)425-257-8810 1(E)PermltServices@everettwa.gov I(W)everettwa.gov/permits _QEC $li ;E'd1�10 1V A�IQN.. PROJECT ADDRESS: 7 Dtj (-eev% W4 u l� W ; � SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ACOMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA,PRE-APP,SS, ETC.) IF APPLICABLE: ❑FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB M JOB M `��>_:�.�,�,,�.�,. ,: �,. bE� -G O .=bA,: 1. E��VI[b �C;I�R�.• 1±1T=O'��IIV�= � �OR _ FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑ DRIVEWAY APRON/CURB CUT FT WIDE ❑Combined Sewer ASPHALT/CONCRETE PAVING SF ❑Separated Storm Sewer ❑ RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL I ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑CLEARING/GRADING/FILL/EXCAVATE 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): ITotal New+Replaced: SF 2o,ovG 2- EAe(5 X 6,4 •ref �AIL&Wk o A 'iA&r L r, k ft VIM OWNER/APPLICANT NAME: errs -.5'e&V%te OWNER/APP. MAILING ADDRESS: STREET ,.9 b kut,NAe-r C-la Q CITY 1r STATE 7\ ZIP ZLS 3 OWNER/APP.PHONE: OWNER/APP.EMAIL: `Required for Work in Public Right-of-Way CONTRACTOR NAME: I v=. tC �N w ' CONTRACTOR ADDRESS: STREET 3 g /� n CITY L„ A&A W OCrA W A STATE, W A ZIP 75 O K4 CONTRACTOR PHONE: Z - 71 yr Y`t CONTRACTOR EMAIL: &44,jLt A a •Pi of vtrt r l &V i , \e- CONTRACTOR LICENSE#(REQUIRED): I.,Y m pp Q Lt, EVERETT BUSINESS LICENSE#(REQUIRED):• 26-IS-7 PRIMARY CONTACT: ❑OWNER /APPLICANT XCONTRACTOR ❑OTHER(Architect,Engineer, Etc.) CONTACT NAME: CC CONTACT PHONE: CONTACT EMAIL: S�Nt v" tG V1��- ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true an correct. ork Ane Airsuant 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.I am the owner,or I am authorized by the owner of this property to perform a 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 2 z - 2--o2q 2 4os- ma aOw athoriz Agent Signature Date (Revised 412112022)