Laserfiche WebLink
BUILDING PERMIT APPLICATION <br />EVERETTSUBMITTAL <br />CITY OF EVERETT PERMIT SERVICES <br />INSTRUCTIONS: See applcable sudarniffluil checklist for subs l requirements and number ofcopes required for review, <br />WAaxlna70N <br />Men drop off completed application plus all required submiXaldocuments to 3200 Cedar Street 2nd Floor Intake Drop Bon. <br />CONTACT INFORIMTION: IPI 425-257-0810I(E)Per-IftServices®evereMva.Bov l(W) evereHwegovlpermlb <br />(Blue or Back Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS STREu 259E CLEVELAND AVENUE PARCELM <br />c m Everett m,,a WA zn 90201 <br />SUITENNITM FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicaael: <br />TEMANTIBUSINESS NAME (if non-residential): <br />LEGALDESCRIPTONfornery natruction: SM1m PINeubdiviskn: Lot No.: pull copy of lang legal tleevipten) <br />CONTACT INFORMATION <br />OWNER NAME:GOrdon Stevens <br />OWNER MAILING ADDRESS: el 2508 Cleveland Avenue <br />Iry Everett STATE WA ze WaH <br />OWNER PIRCUl870-602Z <br />JOYANNER EMAIL: blackandyC t@comcast.net <br />CONTRACTOR COMPANY NAME:.( Wales home Solutions <br />WASTATE CONTRACTOR LIOENSEVREOUIRED):604 9.35194 <br />ICITY OF EVERETT BUSINESS LICENSE g(REMIRED): 65244 <br />CONTRACTOR ADDRESS: tnear14OO 112th Ave. SE <br />Iry Bellevue STATE WA zr 6600A <br />LONTRACTORPHONE:582-4$$-0162 <br />CONTRACTOR EMML:permits@jwhomesolutions.com <br />PRIMARYOONTACT: ❑OWNER CCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Amber McKeehen <br />IcONTACT PHONE:�682,4l!..TT$$Ai $2 <br />CONTACT EMA L:perm a jeshomesOhrLIOOS.Com <br />BUILDING INFORMATION <br />VALUATION OF ViCi $6119,60 ASSOCIATED LAND USE PROJECT p(if applicable): <br />NNNm area mvube W mya"her me" value of all bbor "Werme aw muipment"'Wedho mmgM me wontshuns, wanly "a or,m ) <br />EXISTING USE OF BUILDING: <br />PROPOSED USE OF BUILDING: <br />HEATSOURCE: OGes ElElecb'ic DOMer <br />BUILOINGTYPE:FISFR ❑rownhouae ODupex ElADU EIL&A-Faundly-OUngui ElCammxtlal EAaawmorySrucl <br />TYPE OF PROJECT(check all that apply): ONewGstrul DAddOion ElRemodel ElRepair 11T.I. LIChengeof Use <br />❑Modular ElPonable KIRe-mot DExfedor ARemtion ElTank pionee ground) ❑AGw65wy Structure <br />OFame, over Ttt high ORsckStorsge OPopMM Tub OTank henwas ground) 001her: <br />DESCRIPTION OF WORK: Remove & Dispose Asphalt Shingles and Install DC Arch Shingles <br />ACKNOWLEOGEMENT:IIIevemewatl Mua pp5ulun mJcvnlinnlhe inbmra(ion mnM1inW llereMk Weantlemett WM bupuwuMbMuaptMl mu&emp'y WM <br />wnmet lgead. ant, enJloul me, The granting If Insurer MY aulnonzea aperovM work ant ne OaNaP'ma somehow, Derirtb sheart our be surrnaimdM whi flan tlx <br />Beallrq cards seems being augmented url any circwatmoo lam the owns., wl an Whommt by me owner W gas prommy to parl ure waver Mwhen assail la made, <br />and/amply was the State Connell Law IS 27 RC W and Of 2WA WAC <br />CITya(EreMf OMtlHVaa QMY <br />Diiigned by AmWr PERMIT# <br />Amber McKeehen McKeehan 22 11/15/22 <br />w2Date gzzn.ts 16aeHa gBeD <br />Ownerhodhodaed Agent Signature can (FeNivd 4T1IIo22) <br />