2415 11TH ST 2022-07-21 - Laserfiche WebLink

BUILDING PERMIT APPLICATION 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)425.257.88101(E)everetteps@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECTT SITE INFORMATION PROJECT SITE ADDRESS: STREET 7 1 S ) t jigE 7i-. �� v PARCEL#: CITY J l STATE I ) ZIP quo ; SUITE/UNIT#: Y/ q7 v l FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable): TENANT/BUSINESS NAME(if non-residential): P AtC p/J D LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ft L.'S (4.1911 ko4c ii ouhuit, L L OWNER MAILING ADDRESS: STREET ^ re . 0 x 6 3'j 50 ^?�� CITY 1��I Ine i STATE ZIP c Z, D a— ER PHONE: - Z ,J' 8 f OWNER EMAIL: S'J a v c.I‘)C ?)p r A/! • nit OWN �� 3'7 R� / CONTRACTOR COMPANY NAME: e,)a S c -Sakti i s WA STATE CONTRACTOR LICENSE#(REQUIRED): t' )O Q .S2,i GL) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET z jq z,4 7 erii ove.CITY STATE W ZIP /d"/�� 3 , CONTRACTOR PHONE: 1.53 ' g j a "'i `,7 14 CONTRACTOR EMAIL: j n Cs4 cAeti/CO VF' 'i''f 't"` (C. ei PRIMARY CONTACT: 0 OWNER iiiCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: � CONTACT PHONE: Z,53_-�-" 7`j 7 •-�'0 17', g,„ 'jr}- CONTACT EMAIL: ,>r- f,'C,s+ (� t✓i 1, i P serwe <, .c BUILDING INFORMATION 4 VALUATION OF WORK:$ Zt So Sj — 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: 'L7' r PROPOSED USE OF BUILDING:. 19- �/ HEAT SOURCE: OGas tjgtlectric OOther BUILDING TYPE: ❑SFR OTownhouse ODuplex OADU i�Multi-Family-#Units: OCommercial OAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction OAddition DRemodel ❑Repair DT.I. OChange of Use ❑Modular OPortable e-roof OExterior Alteration OTank(above ground) OAccessory Structure OFence over 7ft high ORackStorage OPool/Hot Tub OTank(above ground) OOther: DESCRIPTION OF WORK: C� � t1 /!Z- -! 6o J oak ns 1 L UR_ 1r-Wf' Teo �O v �(/ Will, 0 ACKNOWLEDGEMENT::/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/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# 7 I vt lOo B Z101 - M Awnari0 riza_d Aaent Sianature Date (Revised 2/8/2021) l