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

INN . 0 I„ 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 I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET a`i J 5 1 1"" $t �t.;\1Yle‘ PARCEL#: CITY Ever Pkl STATE WA ZiP 99)ot SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): 1 a fc bn 1 IIL' LEGAL DESCRIPTION for new construction: Short Plat/subdivision: ' Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A L 4;ts\c,, e C Ow AD c LL G OWNER MAILING ADDRESS: STREET 6 3 o'U 5 y f h (4 C V.A.y / ykc W3c7 CITY C e n-4 e_ n fx:,0- STATE C o ZIP OWNER PHONE: 'OWNER EMAIL: CONTRACTOR COMPANY NAME: S 4 y. li/h,l-e( WA STATE CONTRACTOR LICENSE#(REQUIRED): lji Ain/ 433a t.I ICITY OF EVERETT BUSINESS LICENSE#REQUIRED n 5 #(REQUIRED): t�) ece(e} �02t CONTRACTOR ADDRESS: STREET 13 t 5 \\ pow\,„+.„ St CITY a leZLpnJr:h STATE VA- ZIP aA3lof CONTRACTOR PHONE: 703-t-f 7 a,2 6.i.e. 'CONTRACTOR EMAIL: Cn EISoel `� S4 e w 4+0 PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 743- Li a- 9,614? Ck('“, I t4a,n CONTACT EMAIL: 6,ne14a^c .S4 NO,IN i4e s,Co' BUILDING INFORMATION VALUATION OF WORK:$ i 4 L/yt 'ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair martcet value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: AR.,NV r enA- PROPOSED USE OF BUILDING: .r> Glru,, e HEAT SOURCE: ❑Gas Ll]C:iectrio DOther . BUILDING TYPE: OSFR OTownhouse ODuplex OADU Ig`4ulti-Family-*Units: ta- [!Commercial OAccessory Structure TYPE OF PROJECT(check all that apply): ONew Construction OAddition ❑Remodel V§Repair 0T.1. OChange of Use OModular OPortable ORe-roof ❑Exterior Alteration OTank(above ground) OAccessory Structure OFence over 7ft high DRackStorage ❑Pool/Hot Tub OTank(above ground) OOther: DESCRIPTION OF WORK: ‘I. L Z2 `i Olt n x- sL^e2i-Coc1 -To ACCe47, lur--.V.1,.5, Q.,}Clr.tn . 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. City of Everett Official Use Only / / I PERMIT# ' l '^ 4o/' \a/ 2 t Z — 0 Z I 7wner/Authorized Agent Signature Date (Revised 2/8/2021)