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DRAINAGE MITIGATION QUESTIONS: FT IN HEIGHT STORMWATER DISCHARGES TO: FT WIDE Combined Sewer SF Separated Storm Sewer LF Direct Discharge to Snohomish River or Puget Sound FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: CY MR2 Only MR1-5 MR1-9 LF QUANTITY OF PROPOSED HARD SURFACES: LF Proposed Roof LF Proposed Total New + *Required for Work in Public Right-of-Way CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): EVERETT BUSINESS LICENSE #(REQUIRED): CONTACT PHONE: CONTACT EMAIL: PW Owner/Authorized Agent Signature Date CONTACT NAME: OWNER / APPLICANT CONTRACTOR OTHER (Architect, Engineer, Etc.) City of Everett Official Use Only CONTACT INFORMATION CLEARING / GRADING / FILL / EXCAVATE PRIMARY CONTACT: OWNER / APP. PHONE: OWNER / APP. EMAIL: CITY STATE ZIP CITY STATE ZIP CONTRACTOR PHONE: SITE WORK FOR PROJECT TYPE: SFR-DETACHED TOWNHOUSE DUPLEX ADU MULTI-FAMILY COMMERCIAL INDUSTRIAL PUBLIC WORKS PERMIT APPLICATION PROJECT ADDRESS: CONTACT INFORMATION: [PHONE REDACTED] I [EMAIL REDACTED] I everettwa.gov/permits PROJECT SITE INFORMATION CITY OF EVERETT PERMIT SERVICES IF APPLICABLE: o FRANCHISE/UTILITY COMPANY, ANNUAL BLANKET PERMIT UTILITY COMPANY'S NAME & JOB FILL IN ALL QUANTITIES OF WORK BELOW, AS APPLICABLE: OWNER / APPLICANT NAME: (Revised 4/21/2022) SUBMITTAL INSTRUCTIONS: Email application & submittal documents to [EMAIL REDACTED] or drop off at 3200 Cedar Street 2nd Floor Drop Box IF APPLICABLE: LAND USE PROJECT # (SEPA, PRE-APP, SS, FENCE IN ROW DRIVEWAY APRON / CURB CUT ASPHALT / CONCRETE PAVING RETAINING WALL / ROCKERY IN RIGHT-OF-WAY RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT 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. DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK PERMIT # ADDITIONAL DESCRIPTION (AS NEEDED): OWNER / APP. MAILING ADDRESS: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET STREET CUT/BORE IN PAVEMENT (PARALLEL) CUT/BORE IN PAVEMENT (NON-PARALLEL) POLE WORK / AERIAL / OVERLASH