11322 2ND AVE SE 2022-07-13 - Laserfiche WebLink

• • 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 application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.88101(E)everetteps©everettwa.gov C(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2.2„ Z," emit,S PARCEL#:(X15 73s 000039 o2- CM' E V STATE 4/C-+ ZIP 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) [n� CONTACT INFORMATION OWNER NAME: �Uf1.,e U v ` ((A.— OWNER MAILING ADDRESS:? STREET Il1/4")LZ 2 CITY ,(je.e STATE ZIP JOZ-Q©d OWNER PHONE: '(Z.-S ut Lf gel r OWNER EMAIL: yC Ack.,vt CONTRACTOR COMPANY NAME:Spa Es 14.4,� J�,.- � S'r WA STATE CONTRACTOR LICENSE#(REQUIRED):,$ ,t5et/1fG.4Yt' .. :ITV OF EVERETT BUSINESS LICENSE#(REQUIRED):055-7s CONTRACTOR ADDRESS: STREET/Si)) pv�� C1Y +fe 1/a v .•�C.: STATE CS/� ZIP/OC.V}'1 CONTRACTOR PHONE: 2,46Z 7 r/Z ,'i CONTRACTOR EMAIL:S e f ,1 PRIMARY CONTACT: ❑OWNER AONTRACTOR VLOTHER(Please Specify) K"ry s'Nc C$64.%) CONTACT NAME: CONTACT PHONE: -tee ? 3 ff ek y 4 CONTACT EMAIL: s A, 11 kites` 'e.l g BUILDING INFORMATION VALUATION(WORK: I I,"7;f .. t5u ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall in de the prevailing fair market value of all la r teams,and equipment needed to complete the work,whether actually paid or not.) EXISTING US BUILDING: `lt/Q✓ PROPOSED USE OF BUILDING: ' \ii 170.0._ HEAT SOURCE: Gas fig€lectnc Other BUILDING TYPE: 'ISFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition .®Remodel Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable We-roof DExterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high DRackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:IN r� r: V> � R 4�� t p• It5rtAj +ifs ittr- evle . ..t/ 4.4 fri°'3 la+44.44°, / 5 I 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, and!comply with the State Contractors Law 18.27 RC W and 296.200A WAC. City of Everett Official Use Only �f P IT O Owner/Authorized Agent Signature Date 9 (Revised 2/8/2021)