11400 19TH AVE SE 2017-08-02 - Laserfiche WebLink

I UBLIC WORKS PERMIT r.� PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � F��X 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 1400 ��19th Ave SE �l IF APPLICABLE: � LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.�SEPA 16-022,USACE NWS-2016-579,SMA 16-022,HPA2016-4-693+01,SDP#2016-NW-3493 SITE WORK FOR PROJECT TYPE:❑:>FR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? �LI NO ❑ YES, FROM TO NEW WATER/SEWER SERVICE NEE�ED? � NO ❑ YES,TYPE SIZE SITE YVORK/ RIGHT-OF-WAY APPLICATION INFORMATION DESCRIPTION OF WORK: Cle�iring,grubbing,grading,concrete demolition,placement of crushed rock,and filling of portions of the Green Lantern Park Site to develop a trail compliant with the Departmenl of Justice Americans with Disabilities Act Requirements for public access and to install picnic tables and benches for public use. ❑ FENCE IN ROW FT IN HEIGHT � DRIVEWAY APRON/CURB CUT Type 1 /30' FT WIDE �;�:�y.�j. '�;.7 ❑ASPHALT/CONCRETE PAVING SF � L ,.�1-.�, (]�": - •- i.� .�.,� ,� ;;:;�,'. ❑ RETAINING WALL/ROCKERY IN F'JGHT-OF-WAY LF � L' i.,.,-,. � ' `t ❑ RETAINING WALL/ROCKERY OVE:R 4FT IN HEIGHT FT TOTAL HEIGHT JA� C �O�J CLEARING/GRADING/FILL/EXCAVATE 300 CY J � cirr ❑ CUT/BORE IN PAVEMENT(PARALI_EL) LF �'errr-U,��VERET�3- ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF �'`a`' CONTACT INFORMATION owNER rvamE: City of Everett OWNER MAILING ADDRESS: sTReEr 3002 Wetmore Ave c,T., Everett sTATE WA z,P 98201 OWNER PHONE: OWNER EMAIL: aPP�icarvT NamE: City of Everett Parks and Recreation Department APPLICANT MAILING ADDRESS: sTReeT 802 E Mukilteo Blvd cirr Everett sTArE WA ziP 98203 APPLICANT PHONE: APPLICANT EMAIL: PRIMARY CONTACT: ❑ OWNER �7 APPLICANT ❑ OTHER(Architect, Engineer, Etc.) CONTACT NAME: CONTACT PHONE: 425 257-8341 Dean Shaughnessy corvTa,cT Em,ai�: dshaughnessy@everettwa.gov 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 le w. 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. 1 am the owner or I am authorized by the owner of this property to perform the work for which application is mad�, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# � � !� PVV �� -0�� Owner/Authorized Agent Signature Date (Revised 9/23/2016) + 4 �