10201 27TH DR SE 2026-04-06 - Laserfiche WebLink

PUBLIC WORKS PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov https://everettwa.gov/permits PROJECT SITE:INFORMATI0�1.. �1 PROJECT ADDRESS:lQ SITE WORK FOR PROJECT TYPE: UfSFR-DETACHED ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) 6ESCRii T10N ORSfT 'WOkk FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑ FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: DRIVEW APRON/CURB CUT O 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/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): Total New+Replaced: SF W SS V10L -770,V, CONTACT J N FC Et11MAT10N OWNER/APPLICANT NAME: InIc. i t✓ OWNER/APP. MAILING ADDRESS: STREET / .S' CITY STATE Will ZIP OWNER/APP. PHONE: '42S- 7.5' I113 OWNER/APP.EMAIL: j'11 i �/ K40,C-o 'Required for Work in Public Right-of-Way � �•�� CONTRACTOR NAME: /I CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: OWNER /APPLICANT ❑CONTRACTOR ❑OTHER(Architect, Engineer, Etc.) CONT CT NAME: CONTACT PHONE: - -- Iy3 Ini� i C Q CONTACT EMAIL: i a'j U 10,e.o ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant 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 the 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 PERMIT# �r •- GI PW lJL5 3 O ner/Authorized Agent Signature Date (Revised 411512019)