1916 STATE ST 2022-01-12 - Laserfiche WebLink

LI BRDING PERMIT APPLICATIR CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON 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 g 1 1b Sfi4f£ SF PARCEL#: -__-_. ___----._ _------- --_._--EITY__fVE.01— .__ ---..__-. -------- --------_ ._--- _.. .-STATE_ _kif ZIP -91R29-I SUITE/UNIT#: FLOOR#: I 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: .J g fF icy 6Cidc.\/ OWNER MAILING ADDRESS: STREET 1 I I& S4rlk S# cITY r./FQFT f `^' /�" STATE A- ZIP 7gzo) OWNER PHONE: y3c -26 q 34M7 OWNER EMAIL: CONTRACTOR COMPANY NAME: OWIN/E.P., WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: i1 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: I-)7,5 _ Z 4b _ 3g<j 7 J fFf 691d k/ CONTACT EMAIL: JLGo{cJl✓J9?c& 'fA/IO0.Co11 BUILDING INFORMATION VALUATION OF WORK:$ 5GcO 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: S Pk PROPOSED USE OF BUILDING: J J HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: I ISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ElCommercial ElAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition MRemodel ❑Repair ❑T.I. ❑Change of Use ElModular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ElOther: DESCRIPTION OF WORK: CDNYc 1— fX/54)' )C-) Cfo99i— fO VvEfeon/8moKoot7 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 It / C/3/21 PERMIT# 2,1 r _ © �� O 7 er/Authorized Agent Signature Date (Revised 2/8/2021)