10812 HOLLY DR 2021-11-12 - Laserfiche WebLink

Elm BILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, wASHINCTON 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 l(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 10812 Holly Drive PARCEL#: 00537900000101 CITY Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): 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:Bill Hann OWNER MAILING ADDRESS: STREET 10812 Holly Dr CITY Everett STATE WA ZIP 98201 OWNER PHONE:425-220-5273 OWNER EMAIL: maddoghann@comcast.net CONTRACTOR COMPANY NAME:R&R Foundation Specialist LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):RRFOUFS829DA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 58143 CONTRACTOR ADDRESS: STREET 3409 McDougall Ave Suite 204 cim' Everett STATE WA zip 98201 CONTRACTOR PHONE:425-626-4841 CONTRACTOR EMAIL:barbara@rrspecialist.net PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-626-4841 Barbara Stasiak CONTACT EMAIL:barbara@rrspecialist.net BUILDING INFORMATION VALUATION OF WORK:$20,493.75 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:SFR PROPOSED USE OF BUILDING:SFT HEAT SOURCE: ❑Gas ❑Electric ❑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.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) EAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ✓❑Other: Foundation Repair DESCRIPTION OF WORK: crew will install helical piles with 6" steel channel with 6x6 post bases with adjustable pads to stabilize and lift home to maximum practical recovery 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. City of Everett Official Use Only PERMIT# icy L -`,� 6/7/2021 LJ' Owner/Authorized Agent Signature Date (Revised 2/8/2021) /