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

NM `! 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)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET a`I is . i l-,, y1.- 6 ;,)-,r c PARCEL#: CITY j ve Xe4 ' STATE WA ZIP 9 w)Q 1 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): \arc 6n 11 Tt'' LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A L 4 ,tsl�,�e-C o'—'AO c IA C OWNER MAILING ADDRESS: STREET 6 3 az) Syche�SC 1,Jc.y I like 43c> CITY C&A") .e n A,h 1- STATE C a ZIP OWNER PHONE: (OWNER EMAIL: CONTRACTOR COMPANY NAME: S 4 y W 4 l e( WA STATE CONTRACTOR LICENSE#(REQUIRED): c,)e 11/ L 3a I-I (CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): :l_ece t CONTRACTOR ADDRESS: STREET `('} �� 13� � P�w�,„-1,,,. St CITY A )elca„Jr:A\ STATE VA- ZIP a2.3/L/ CONTRACTOR PHONE: 703-L/7 a.26ie (CONTRACTOR EMAIL: C /ion PRIMARY CONTACT: ❑OWNER $CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ff 163- t•(7 �.- `.�6 1 4? G�n r,4 18(4.0 CONTACT EMAIL: 6 n&I40 .c ,Sh�'i&`,C o i BUILDING INFORMATION VALUATION OF WORK:$ I N ,yort? (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: 04.-R„r.a t„) PROPOSED USE OF BUILDING: Nv Ci-rs C HEAT SOURCE: ❑Gas Vlectric DOther BUILDING TYPE: DSFR DTownhouse DDuplex DADU Atvlulti-Family-#Units: ,') DCommercial DAccessory Structure TYPE OF PROJECT(check all that apply): DNew Construction DAddition DRemodel 4Repair DT.I. ❑Change of Use ❑Modular DPortable ORe-roof ❑Exterior Alteration OTank(above ground) DAccessory Structure DFence over 7ft high DRackStorage DPool/Hot Tub OTank(above ground) DOther: DESCRIPTION OF WORK: M oUc n y2 61,eearcocto. Ti aCCe“ 1ur^t)^sm,, Q.A.ClnTh. 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 1 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 I PERMIT# 5 s1,^ /4(9-1 Z 21 l Z — 07,5 )wner/Authorized Agent Signature Date (Revised 2/8/2021)