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PUBLIC WYORKS PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 <br /> WASHINGTON (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov https://everettwa.gov/permits <br /> P <br /> PROJECT ADDRESS: Ic L-9 W-7t <br /> SITE WORK FOR PROJECT TYPE: PeSFR-DETACHED EITOWNHOUSE EIDUPLEX EIADu EIMULTI-FAMILY EICOMMERCIAL EIINDUSTRfAL <br /> IF APPLICABLE: OLAND USE PROJECT#(SEPA, PRE-APP,SS, ETC.) <br /> F I <br /> T.,e" <br /> T R <br /> FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: <br /> 0 FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: <br /> E] DRIVEWAY APRON/CURB CUT FT WIDE 0 Combined Sewer <br /> El ASPHALT/CONCRETE PAVING SF 11 Separated Storm Sewer <br /> XRETAINING WALL I ROCKERY IN RIGHT-OF-WAY LF 11 Direct Discharge to Snohomish River or Puget Sound <br /> 0 RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: <br /> El CLEARING/GRADING/FILL I EXCAVATE CY EIMR2Only OMR1-5 11MR1-9 <br /> El CUT/BORE IN PAVEMENT(PARALLEL) LF QUANTITY OF PROPOSED HARD SURFACES: <br /> El CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area: SF <br /> El POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape: SF <br /> ADDITIONAL DESCRIPTION(AS NEEDED): Total New+Replaced: SF <br /> - 11 Yx--bim [114 <br /> S-Q� awid j"A I _ ,5tdZ_3 <br /> WAWEA " M I <br /> g <br /> OWNER/APPLICANT NAME: <br /> OWNER/APP. MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER/APP. PHON I E:' UZL I OWNER/APP.EMAIL: k4.t Oki j�? rjza7' <br /> *Required for Work in Public Right-of-Way <br /> CONTRACTOR NAME: L" �Ands t&anm . <br /> CONTRACTOR ADDRESS: qjj 11 <br /> ,tRTREET <br /> f"vg/y-j& CITY STATE ZIP <br /> CONTRACTOR PHONE: 0 <br /> d'Ap tip <br /> '?6 FCONT CTOR EMAIL <br /> CONTRACTOR LICENSE#(REQUIRED): O 60 ve I EVERETT BUSINESS LICENSE#(REQUIRED)45 701 <br /> PRIMARY CONTACT: OWNER /APPLICANT 0 CONTRACTOR El OTHER(Architect, Engineer, Etc.) <br /> CONTACT NAME: CONTACT PHONE: -.2-V 6 <br /> 1,017AAft rl_� CONTACT EMAIL: ILUANA Q I- ka_f_' D111 (P W & kbt - tbYM <br /> ACKNO DGEMENT-I have reviewed this application and confirm the information contained he in is true and correct. Work done purst,�nt to this permit must <br /> comply current federal,state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be <br /> 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 <br /> perform the work for which application is made,and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> (�Z C4A4 A4 � OV&G IPW <br /> ut 6w44r/Z' MAgent Signature Date (Revised 411512019) <br />