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S#or m`wa er Manag±ement Questionnaire For <br /> Single Family Res dentia) / Duplex / Small Projec#s` <br /> , <br /> Step 1:Fill in the Quantities below: <br /> The total amount of proposed hard surfaces(rooftop,pavement, etc.)for my project site is: g(o .�._._ S.F. (Box 1) <br /> The amount of existing hard surfaces on my project site that will be removed or replaced is: 1.".. S.F.S.._-.__' (Box 2) <br /> The amount of net new hard surfaces on my site(proposed minus existing to be removed/replaced)is: ..-b 3.. S.F. (Box 3) <br /> Step 2: Evaluate the three statements below by selecting TRUE or FALSE: <br /> 2. The value of B.. +Box 3=Box 1,above. (circle one) Reserved for City of Everett Public Works Approval Stamp <br /> ANSWER: or FALSE <br /> *If False,re-e`. ..to your areas and try again. <br /> APPROVED <br /> 2. The value in Box 1 above is •!e square feet or more. (circle one) PUSLI W RKS DE RT NT <br /> ANSWER: TRUE or FALSE BY <br /> *If False,only complete General In ormation&Construction Storm water Plan. <br /> DATE La-a- 20/4 <br /> 3. The value in B. .bove is less than 5,000 square feet. (circle one) CITY OF EVERETT REVIEWED FOR PERMIT <br /> ANSWER: 1M) or FALSE PW161r©/O <br /> *If False,submit an ngineered Drainage Report addressing MR#1-9. <br /> Step 3: Proceed with this entire Questionnaire if all 3 answers above are TRUE. <br /> GeneralInform ion <br /> Project Site Address: i'�Al,M L R- / VE. 4} 5't 2© l <br /> Prepared By: 'E'53 VA�J W t iJ L- -4CQuls 17/1" 1 a v. 1467 . � f! <br /> Date Prepared: )//9 ///6 <br /> Exis nig to(nfor 66nation „ <br /> 1. Please describe the existing structures, hard surfaces,slopes,drainage patterns,drainage <br /> pipes,vegetation,etc. <br /> 2. Please provide the following quantities of existing hard surfaces in square feet: <br /> Existing Roof Area: <br /> Existing Other Hard Surfaces(pavement,gravel,etc.): <br /> CITY OF EVERETT I 3200 Cedar Street j Everett,WA 98201 I 425-257-8810 j everettwa.gov <br />