2405 STATE ST 2022-04-05 - Laserfiche WebLink

E BLDING PERMIT APPLICATN CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WA$HINGTON 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 2405 State Street PARCEL#: 00515653601300 cry 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:Robert Wyatt OWNER MAILING ADDRESS: STREET 2405 State Street CITY Everett STATE WA zip 98201 OWNER PHONE:425-879-7698 OWNER EMAIL: jesuszone@live.com 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 CITY Everett STATE WA Zip 98201 CONTRACTOR PHONE:425-626-4841 CONTRACTOR EMAIL:barbara@rrspecialist.net PRIMARY CONTACT: ❑OWNER 1 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-626-4841 Barbara Stasiak CONTACT EMAIL:barbara@rrspecialist.net BUILDING INFORMATION VALUATION OF WORK:$20,184.00 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:SFR 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 ETA. ❑Change of Use ❑Modular ElPortable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: crew will install helical piles 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. _-L`` �� /� City of Everett Official Use Only 5c Z'L . �ZG�s ai 3/23/2021 PERMIT# B21 03 s 0—1 rt- Owner/Authorized Agent Signature Date (Revised 2/8/2021)