Laserfiche WebLink
in BIIII..DING PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 3219 52 nd PI SW PARCEL#: 00396700200600 <br /> CITY everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: n/a FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME (if non-residential):Ilia <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:MATTHEW&KRISTEN ELLIS <br /> OWNER MAILING ADDRESS: STREET SAME AS SITE <br /> CITY STATE ZIP <br /> OWNER PHONE:(812) 272-8366 OWNER EMAIL: ellisma01@yahoo.com at- <br /> CONTRACTOR COMPANY NAME:BOLT CONSTRUCTION ! <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):BOLTCCL814QK CITY OF EVERETT BUSINESS LICENSE#(REQUI' D : ''Plied l <br /> CONTRACTOR ADDRESS: STREET906 SE Everett Mall Way STE 409 a <br /> CITY Everett STATE WA ZIP nr208 <br /> CONTRACTOR PHONE:(425) 595-0175 CONTRACTOR EMAIL:alex@boltconstruction-wa.com <br /> Y <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR [JTHER(Please Specify)J7 <br /> CONTACT NAME: CONTACT PHONE:(425) 595-0175 <br /> Alex Tsym balyu k CONTACT EMAIL:alex@boltconstruction-wa.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $50000 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> — <br /> EXISTING USE OF BUILDING:Living Space <br /> PROPOSED USE OF BUILDING:Living Space <br /> HEAT SOURCE: Eng lectric ether j <br /> BUILDING TYPE:FR ■ownhouse II,uplex [—DU Filulti-Family-#Units: {:ommercial ccessory Structure <br /> TYPE OF PROJECT(check all that apply): !Sew Construction ,ddition remodel repair 7.1. :hange of Use <br /> _lodular [lortable e-roof Ixterior Alteration .ank(above ground) kccessory Structure <br /> ence over 7ft high :ackStorage 'ool/Hot Tub —ank(above ground) )they: BASEMENT INTERIOR ALTERATION <br /> DESCRIPTION OF WORK: <br /> Basement alteration, which includes changing basement layout, flooring and <br /> reconfiguring the staircase. <br /> 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 <br /> urrent 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 <br /> Suilding 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. <br /> and 1 corm.`••the State Contractors Law 18.27 RCVV and 296.200A WAC. <br /> J City of Everett Official Use Only <br /> SiO"' . 03/13/21 PE ZOO, (' r ber <br /> t -r orized Agent Signature Date (Revised 2/8/2021) <br /> /2— <br />