10201 1ST DR SE B 2025-04-18 - Laserfiche WebLink

ECIEOVIE BU!DING PERMIT APPLICATIa0 MAY 2 i 2123 CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and nedIPPOREVEREiT iew, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar t Box. CONTACT INFORMATION: (P)425-257-8810 j(E)PermitServices@everettwa.gov I(W)evere r w g / It (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET \D2D\ E PARCEL#: CITY STATE wit. ZIP cyB2ag SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: V\ S ^\pp`JJ t� OWNER MAILING ADDRESS: STREET 10J\ \ \ tc SG CITY . -/VQ.--) STATE \MN ZIP 9 2 2LD 9 OWNER PHONE: 'k2S 3SO-(oO'i O OWNER EMAIL: Y �Q -04.\Aa\V10\® l-7�,�,o,A , ram CONTRACTOR COMPANY NAME: O W•N� \\vv WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET N4Z- CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: tin 393-(00 tf 0 1 m\Dam CONTACT EMAIL: 'Fat c ty\a‘y��Q G�AI 1 Covk \L- BUILDING INFORMATION a,ha woY Gv4Aa;) • cow— VALUATION OF WORK:$ (50r000 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: �FIZ PROPOSED USE OF BUILDING: cSFR., HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: FR Ill Townhouse CI Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction EAddition ❑Remodel Lair ❑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: 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.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only"a PERMIT# S�2>o I�a / 6' Owner/Authorized Agent Signature Date (Revised 4/21/2022) ••J