2232 12TH ST 110 2022-10-10 - Laserfiche WebLink

E BSLDING PERMIT APPLICAIN 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 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink my Please) PROJECT SITE INFORMATION PROJECT SIT ADDRES STREET 2232-12th St. PARCEL#: 29051700213300 CITY Everett STATE WA ZIP 98201 SUITE/UNI #: 1 ;2/ FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/B INESSE(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: See Attached Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:ALS CASCADIAN OWNER LLC do Eric Anderson OWNER MAILING ADDRESS: STREET 2232- 12th St. err- Everett STATE WA ZIP 98201 OWNER PHONE:1 (619)234-9989 OWNER EMAIL: eanderson@plpinc.net CONTRACTOR COMPANY NAME:GR General Construction and Remodeling LLC-Yuriy Grigorash WA STATE CONTRACTOR LICENSE#(REQUIRED):GRGENGC950Q1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57593 CONTRACTOR ADDRESS: STREET 10029 S. Tacoma Way, Suite E-7 CITY Lakewood STATE WA Zip 98499 CONTRACTOR PHONE:(253) 343-3595 CONTRACTOR EMAIL:ygrigorash@grgeneral.net PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Contractor Agent CONTACT NAME: CONTACT PHONE:206-281-7500 hris Bacus-Pacific Engineering Tech. CONTACT EMAIL:cbacus@pacengtech.com BUILDING INFORMATION VALUATION OF WORG ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prt value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUrtments (Residential) PROPOSED USE OF BUILDING:No Change HEAT SOURCE: ❑Gas ©Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ✓❑Multi-Family-#Units: 1 ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ©Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof DExterior Alteration ❑Tank(above ground) DAccessory Structure ❑Fence over 7ft high ❑RackStorage DPool/Hot Tub ❑Tank(above ground) Daher: DESCRIPTION OF WORK: See Attached � - ,.82.� mar (.,i,,,,%-c—t k 1,C , A.k..,1„,c0,1k._ 4:14....qA.R._,c.------ te.v......e_ iJutiza-t-t...), 1 If 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 PERMIT# „--- _ 1/20/22 ZlZ.-03 Owner/Authorized Agent Signature Date (Revise 2/8/2021) ';