HomeMy WebLinkAbout54_City-of-Arlington-Permit-Application-WO-100146290-0110 . CONSTRUCTION PERMIT APPLICATION
Community&Economic Development
City of Arlington • 18204 5911,Avenue NE • Arlington,WA 98223 Phone(360)403-3551
CIVIL(TYPE I) GRADING/PAVING/DRAINAGE(TYPE I1) 71 RIGHT OF WAY(TYPE I11) 21
TYPE I&11 ONLY NEW DEVELOPMENT 71 REDEVELOPMENT
Project Name: Replace damaged fiberglass streetlight pole
Snohomish County Tax Parcel I.D.#: 01030500000100
Project Address/Location: 17323 73RD AVE NE / 172ND ST NE & 73RD AVE NE intersection
Description of Project: Replace damaged streetlight pole with new pole
OWNER
Name:
Address:
City: State: Zip: Phone:
Email:
APPLICANT
Name:Snohomish County PUD
Address:PO BOX 1107
city: Everett State: WA zip: 98206-1107 Phone: 425-238-8083
Email: permits@snopud.com
ENGINEER
Name: Mike Fleming
Address: 2320 California Street
city: Everett State: WA zip: 98206 Phone: 425-238-8083
Email: MPFleming@snopud.eom License#: Expiration:
CONTRACTOR
Name: Snohomish County PUD
Address: 2320 California Street
city: Everett State: WA Zip: 98206 Phone: 425-783-1000
Email: License#: Expiration:
I, hereby certify that I have read and examined this application, City of Arlington Municipal Code, Standard Plan &Specifications. Performance of the
proposed work shall follow all applicable laws and regulations.The owner/applicant shall assume full and complete responsibility for said work and shall
be responsible for the acquisition and compliance of all applicable permits and/or authorizations which may include,but not limited to, Right of Way
Permit,WSDW Hydraulic Project Approval(HPA),WSDOE Notice of Intent(N01),National Pollutant Discharge Elimination System(NPDES),Army Corp.of
Engineers Permits,the requirements of the Endangered Species Act,and the Forest Practices Application(FPA).
Signature "'
Print Name: uy 111Li_ M, Date: it kb
Pagel of 2 REV11/2021
Complete package constitutes all items. Only complete submittals will be accented.
Civil-Submittal Requirements.Type I: Electronic files shall be PDFon USB flash-drive,email,or drop-box
❑ Complete Application
❑ Construction Plans including cut/fill quantities
■ 2 full size plan sets 22"x 34"
■ PDF file of the complete plan set
■ 2 full size set of landscape plans 22"x 34"
❑ Marysville Utility plans,if applicable(2 sets)
❑ Drainage Analysis including calculations and downstream analysis (2 sets)and (PDF file);refer to Stormwater Drainage
Requirements
Cl Geotechnical Report(2 sets)and(PDF file)
D SEPA is required if 500 or more cubic yards of cut/fill is proposed(not required if included with a Land Use Permit);if
there is not a Land Use Permit associated with the project,Public Notice Materials will be required
❑ Grading cut/fill quantity:
❑ Design Vehicle-demonstrate turning radius include 45'Fire truck,dual axle,256-inch wheelbase
❑ Drafts of easement(s)dedication(s),and/or CAPE(s)for review
❑ Flood Hazard Permit Application and required documentation if project is within 100-year flood plain;refer to Flood
Hazard guidance documents
❑ Construction Calculation Worksheet
❑ NPDES Permit(if required);See Storm Water Drainage Report,New or Redevelopment Flowcharts
❑ Assurance Device will be required prior to Permit Issuance(Bond or Assignment of Funds)
❑ Permit Fee due at time of permit submittal
Grading,Paving/Drainage Submittal Requirements.Type II:Electronic files shall be PDF on USB flash-drive,email,or drop-box
❑ Complete Application
❑ Construction Plans including import/export quantities
■ 2 full size plan sets 22"x 34"
■ PDF file of the complete plan set
❑ Drainage Analysis including calculations and downstream analysis(2 sets)and(PDF file); refer to Stormwater Drainage
Requirements
❑ Geotechnical Report(2 sets)and(PDF file)
❑ SEPA is required if 500 or more cubic yards of cut/fill is proposed(not required if included with a Land Use Permit)
❑ SEPA Public Notice Material Requirements:
■ Snohomish County Assessor's Quarter Section Map: ❑ Show Subject Property ❑ Show 500 ft.Boundary
■ Current Owner List(of properties within 500ft.radius)including the following: a
❑ Tax Parcel ID Number(s) ❑ Owner(s)Full Name(s) ❑ Owner(s)Mailing Addresses)
❑ Current Resident&Property Address(if property owner doesn't reside at the property)
• Mailing Material:Provide❑ white,#10 envelopes with the following affixed to the envelopes:
❑ Postage ❑ Mailing Labels ❑ Return Address labels: 18204 591h Ave NE,Arlington WA 98223
❑ Grading cut/fill quantity:
❑ Construction Calculation Worksheet
❑ NPDES Permit(if required);See Storm Water Drainage Report,New or Redevelopment Flowcharts
❑ Permit fee due at time of permit submittal
Right of Way Submittal Requirements,Type III: Electronic filesshall be PDFon USB flash-drive,email,or drop-box
1❑ Complete Application.
❑ Construction Plans.
❑ Traffic Control Plan.
❑ Road Closure Request.
❑ Temporary Erosion&Sediment Control(TESC)Plan.
❑ Certificate of Insurance with the City of Arlington named as Additional Insured.
® Assurance Device will be required prior to Permit Issuance (Bond or Assignment of Funds).
Engineers Estimated Cost of Construction;$8,000
❑ Permit fee due at time of permit issuance.
Page 2 of 2
I