10501 13TH AVE W 2021-11-17 - Laserfiche WebLink

BIDING PERMIT APPLICATIA CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINrSTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET ( OF'61 ` pisyy PARCEL +#Y ' /� �1�/� CITY 940.42 _ STATE VC ZIPeigfr� SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATIONIII (if applicable): (i' ` TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 1.4 `NkeQ t'] \M G ,, OWNER MAILING ADDRESS: STREET 10 Pcigger11 rr�`' , COY STATE" V' ZIP4 _ _ 4 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: dWN WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: El OWNER ❑CONTRACTOR Xi OTHER(Please Specify)__r,asio p , likAN CONTACT NAME: CONTACT PHONE:/. 41 .4cc its CONTACT EMAIL: (�eo _d 1erDiNperisl4wl .rorK BUILDING INFORMATION VALUATION OF WORK:$ 6 W t ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: ! o !'firsip PROPOSED USE OF BUILDING: kilarLe HEAT SOURCE: ❑Gas Alectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) Qthe': 4�J a C.14t �( DESCRIPTION OF WORK: 1 eatoqa Fgei 4\-kiJDckYi MAS S c'Lrt 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 co te Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only l 61 PERMIT# 5 2_l 0 9 — a4 lL Owner/Authorize g nt ignature Date (Revised 2/8/2021) i/