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

• mot 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)425.257.8810)(E)everetteps@everettwa.gov)(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECTy SITE INFORMATION PROJECT SITE ADDRESS: STREET 7 4.15 J i • F he Q PARCEL#: a�A+► ( r t CITY akk.- ., i j / STATE F i Z�' - e fir"„ SUITE/UNIT#:'T tj 1 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): pAILG cno l LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) y� } CONTACT INFORMATION OWNER NAME: R i,5 (4151114.40A. Ow i 4 C— OWNER MAILING ADDRESS: STREET re b f1�C jj�fl�3 3 q 50 ��y CITY ,/ '..D t;4'il' ^Vd/ 'r -"� STATE! ZIP q i C t2 OWNER PHONE:6 I `l� Pq OWNER EMAIL: 5L/1—Ve .I I I e QlPy►JC ` Nta` �^Z3� CONTRACTOR COMPANY NAME:pares`.I a S (c . WA STATE CONTRACTOR LICENSE#(REQUIRED): ( {c)I)J .S r L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET ,5jq v A#' t7 J � if - S;• �q� CITY i'+ +�` STATE i 4 zIP ?Q"3 CONTRACTOR PHONE: Z-73 ' g '"0/7"'{, CONTRACTOR EMAIL: ( ty 0 t; piciaSIC F serfw r '- tch4-t PRIMARY CONTACT: D OWNER OCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2,53 7(j 7-9 ti 11, CONTACT EMAIL: S4e,teb c.ie j u r •C BUILDING INFORMATION VALUATION OF WORK:$ ? j 5t? ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market va of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: k'LQ,'r'"/ Jf.i7 PROPOSED USE OF BUILDING:. HEAT SOURCE: ❑Gas glectric DOther BUILDING TYPE: DSFR OTownhouse ❑Duplex DADU Julti-Family-#Units: OCommercial DAccessory Structure TYPE OF PROJECT(cheek all that apply): ONew Construction DAddition ORemodel ORepair DTI OChange of Use ❑Modular OPortable Re-roof DExterior Alteration OTank(above ground) DAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub OTank(above ground) ❑Other: DESCRIPTION OF WORK: I/a!( JF11 ,7-it-Cl &tJ-c#t . CtligicTHE Z� D\A 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 t 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# � o�_ �1 712q Zoz/ U e�,..nerrertl,erheed Anent Sianature Date (Revised 2/812021) 11