2415 11TH ST 2022-05-24 - Laserfiche WebLink

MIN . • `l BUILDING PERMIT APPLICATION • EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed apation plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)plic 425.257.8810 (E)everetteps@everettwa.gay (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET a`I 15 )c u t 1 %/1 -s C PARCEL#c crry E Ve.rek� • STATE WA ZIP 9 75)[51 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): r,,c c 6n )In" LEGAL DESCRIPTION for new construction: Short Plat/subdivision: ` Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A L 4 4,tskr-Are.C O..- AD c ► I C OWNER MAILING ADDRESS: STREET 63 cz> Sy Nh e C Wi y I ykc W3c7 cnv C 2A-F .e n/i,h 1- STATE C 0 ZIP OWNER PHONE: (OWNER EMAIL: CONTRACTOR COMPANY NAME: S 4'lc W,4.e( WA STATE CONTRACTOR LICENSE#(REQUIRED): lj< <W q 3.)L 1 (CITY OF EVERETT BUSINESS LICENSE :#REQUIRED n ( ) iiec¢i(,} .u2t CONTRACTOR ADDRESS: STREET I3) i pal,A„,.-},,„ St CITY A )e zc,,,,, J\ STATE V A- ZIP a 2,30( CONTRACTOR PHONE: 703—Of?a---2 6 tie 'CONTRACTOR EMAIL: 1So� C c,}e PRIMARY CONTACT: El OWNER 5 ' D✓� CONTRACTOR 0OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 703— It72— 2614? Cht^,4 1814.4 CONTACT EMAIL: Cneisa, c- S�.y,_t L4e Co/,1 BUILDING INFORMATION VALUATION OF WORK:$ 1 5 6 ere, 'ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair madet value of all labor,materials,and equipment needed to complete the work,whether actually paid or not) EXISTING USE OF BUILDING: AR,c. t.A,QA4 PROPOSED USE OF BUILDING: No (t.,,,, C HEAT SOURCE: ❑Gas NEfectric OOther BUILDING TYPE: OSFR OTownhouse ❑Duplex ❑ADU ®Multi-Family-#Units: 39 OCommercial OAccessoryStructure TYPE OF PROJECT(check all that apply): ONew Construction DAddition DRemodel 1 (Repair DT.I. ❑Change of Use OModular OPortable ❑Re-roof ❑Exterior Alteration OTank(above ground) OAccessory Structure OFence over 7ft high DRackStorage OPool/Hot Tub OTank(above ground) OOther: DESCRIPTION OF WORK: L .e cn 0Ui A S-2" !1.n2es-coci= \v Ac£e�,S tur^L0-%*-5, Qtit-C-ln1ny vt»A� }? �` 11) teX ACKNOWLEDGEMENT:1 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.lam the owner,or l 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# ,4tt40f �a 41/2k 6 2-1,1 Z- 021, )wrier/Authorized Agent Signature Date (Revised 2/8/2029)