5512 FAIRVIEW AVE 2022-11-17 - Laserfiche WebLink

mai B LDING PERMIT APPLICAT1 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET <-S I d- i ot.t[[ PARCEL#: CITY `(rel(e {J STATE (/4041/4. ZIP SUITE/UNIT#: FLOOR#: ADDITIONAL LO TION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): t!/P.,� C r;ppevt S€(V Duo 6.0 NdY ( u, '$e 7 LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: <e4U pio 6 ,A)a`C f k E v`e(e 1 WA STATE CONTRACTOR LICENSE#(REQUIRED): T'Y U pL S 71AtrY OF EVERETT BUSINESS LICENSE#(REQUIRED):06-01,V,6 CONTRACTOR ADDRESS: STREET 18 30 A t L V 4 ram` ' /f CITY s'jt o iaa e S STATE bicA ZIP gli�.�9�0 CONTRACTOR PHONE: VS': S'3S-_ L2 / CONTRACTOR EMAIL: (I()Joy ik'•e( Sen),1O•e Ue(r//tom,¢ o ipt PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: }} J,/ CONTACT PHONE: l7/a.5"� S`-j' _(94-I q i?od� (/tea,IICe�2 CONTACT EMAIL: ,r( JGLU' CY gc( )pto vki-t;ferj t/,c`t(OIIA BUILDING INFORMATION VALUATION OF WORK:$ 06v, 0-1-1 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair filarket value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: awl;devt?:4 PROPOSED USE OF BUILDING: 1Le6(jLe i t i.4, HEAT SOURCE: ❑Gas gElectric ❑Other BUILDING TYPE: I2SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family � #-Units: � ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition V1 rWriodel . `epair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: 1(� � 1444 Waal 13 �,wi j ® LA e�,f(01- de-pfa 6-e- 6 i A S)4 /( t)//t,�'t Gl� 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 .tate,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 Offi ':l efore 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 corn- the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only / PER�}4T# 2,O 0691.1 IVi-7/)-04_ 1!1/� L•� =r uthorized Agent Signature (Revised 4/21/2022) I/Z