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PUBLIC WORKS PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P)425-25T-UlO 1 FAX 425-257-8857 1(E)everetteps@everemva.Goal l https:llevemtwa.gov/p rmits <br />PROJECT S1TE INFORMATION <br />PROJECT ADDRESS: 2717R731 Federal Avenue Everetl, Washington <br />SITE WORK FOR PROJECT TYPE: OSFR-DETACHED OTOWNHOUSE E3DUPLEX I]ADJ I]rAl FAMILY ®COMMERCIAL E31NDUSTRIAL <br />IF APPLICABLE: G LAND USE PROJECT X (SEPA, PRE-APP, SS, ETC.) <br />W APPLICABLE: 13 FRANCHISEIUTILITY COMPANY, ANNUAL BLANKET PERMIT K <br />UTILITY COMPANY'S NAME B JOB N: JOBN <br />DESCRIPTION OF SITE WORK I RIGHT-OF-WAY WORK <br />FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: <br />I]FENCE IN ROW FT IN HEIGHT <br />O DRIVEWAY APRON I CURB CUT FTWIDE <br />❑ ASPHALT I CONCRETE PAVING SF <br />O RETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF <br />0 RETAINING WALL I ROCKERY OVER OFT IN HEIGHT _FT TOTAL HEIGHT <br />❑ CLEARING I GRADING I FILL I EXCAVATE CY <br />O CUTBORE IN PAVEMENT(PARALLEL) 20 LF <br />CI CUTBORE IN PAVEMENT(NON-PARALLEL) LF <br />O POLE WORK I AERIAL I OVERLASH LF <br />AOmTIONAL DESCRIPTION AS NEEDED : <br />DRAINAGE MITIGATION QUESTIONS: <br />STORMWATER DISCHARGES TO: <br />OCombined Seas <br />D Smareletl Smrm Swer <br />G Dires Dbdlarys to SroMmisb River Or Puget Sound <br />TRIGGERED REQUIREMENTS.' <br />13MR20nly 13MRI-5 OMR1-9 <br />QUANTITY OF PROPOSED HARD SURFACES: <br />vmposed Raol Area: SF <br />Proposed Hardsm". SF <br />Total Navy♦ Replaced 3F <br />Drill 18 borings in the City of Everett right-of-way using a direct push drill rig for the collection of soil <br />samples. The borings will be immediately backfilled and finished to match the existing grade with <br />either dyed concrete or asphalt. <br />CONTACT INFORMATION <br />OWNER I APPLICANT NAME: Robert Thompson <br />OWNER IMP. MAILING ADDRESS STREET 309 South Clovendale Stuart <br />r Seattle STATE WA to. 98108 <br />OWNER I APP. PHONE: a 12065105855 <br />OWNER IMR. EMAIL roberl.thompsan@cardno.com <br />'Required for Work In PuNkc RignlaCWay <br />CONTRACTOR NAME: Cardno <br />CONTRACTORADDRESS: ssr 309 South Cloverdale Street <br />CITY Seattle sTAm WA on, 9e108 <br />CONTRACTOR PHONE:+12065105855 <br />CONTRACTOR EMAIL. roben.Mompson@wMno.com <br />CONTRACTOR LICENSE NtREQUIRED): CARDNPSSSR3 <br />EVERETT BUSINESS LICENSE tl(REQUIRED): Gi <br />PRIMARY CONTACT: ❑ OWNER I APPLICANT 000NTRACTOR ❑ OTHER (Architect Engineer, Etc.) <br />CONTACT NAME: <br />Robert Thompson <br />CONTACT PHONE: T12065'0 5855 <br />CONTACT EMAIL hat hampeon@rardno.mm <br />ACKNOWLEDGEMENT. I have howver this automation ads conOrm Meinbnnafion moral hereon is true and myrot Wwkdmepumu tiothia�tmua! <br />am wiM cumay Sam <br />Bue,entl he WInstant Greeningraapermtterany!'resappmla wok ea no rtamonhosen men. eowdearumuet Nnfhe <br />aullwn'mdinw M "w MB watim Olficial6e/mebo ym(h Ountleranyciraums wl8.amthe md2orl amaullrcn'mO6y Me ownerol Mis pmpedyb <br />per/ Me wok hrwhkh epp'rceloen la n�eYe, entllcomply uvlh Me$letef.'dRra`Ide lew iB2]RCWentl49a NpA WAC. <br />Gryo/Ewntt O/flNBI Use Q'ny <br />PERMIT# <br />Robert Thompson as, ece,.wulm � July 27, 2D2t PW <br />OwnerfAuthorlmd Agent Signature Dale (Revised f/]20f9) <br />