HomeMy WebLinkAbout20240611_PWD3796_App 40 CONSTRUCTION PERMIT APPLICATION
Community and Economic Development
City of Arlington • 18204 59th Avenue NE • Arlington,WA 98223 Phone(360)403-3551
CIVIL(TYPE I) GRADING/PAVING/DRAINAGE(TYPE II) RIGHT OF WAY(TYPE III)
Project Name: Harmony at Arlington
Project Address/Location. 7417 204th Street NE Tax Parcel I.D.010511-003-040-00
Description of Project: Early Grade for fill
Early Grade for fill
Project Size in Acres: 4.38 ac DOE General Construction Stormwater Permit#: to be determined
11"MEN
Name:Harmony at Arlington, LLC
Address: 4012 148th St SE, PMB#30
Ci : Mill Creek State:WA zip: 98012 Phone: 425.869.1212
Email msabtahl@outlook corn
Name:Harmony at Arlington, LLC
Address: 4012 148th St SE, PMB#30
City: Mill Creek State: WA zip: 98012 Phone: 425.869.1212
Email:msabtahi@outlook.com
ORN
Name:Tyler Foster/Land Technologies, Inc.
Address:18820 3rd Ave NE
Ci : Arlington State: WA Zip: 360.652.97 - hone: 360.652.9727
Email: tyler@landtechway.com License# 20110055 Ex iration. 9/30/24
��� '��
3
Name:
Address:
Ci : State: hk Zip: Phone:
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(NOi),National Pollutant Discharge Elimination System(NPDES),Army Corp.of
Engineers Permits,the requirements of the Endangered Species A and the Forest Practices Application(FPA).
Signature
Print Name: Date:
Pagel of 2 REV2/2024