2318 VIRGINIA AVE 2023-03-31 - Laserfiche WebLink

BUILDING PERMIT APPLICATION 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 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION i PROJECT SITE ADDRESS: STREET PARCEL #: CITY — STATE ZIP SUITE/UNIT M �i C e FL R� ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSIN S NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivisi( Lot No.: at opy of long legal description) CONT CT FORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CITY STAT P OWNER PHONE: OWNER EMAIL: CONTRACTOR COM ANY NAME: A Q, � WA STATE CONTRACTOR LICENSE #(REQUIRED): I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNE AD CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK: $ I ASSOCIATED LAND USE PROJECT # (if applicable): (Valuation shall Include the prevailing fair arket va of all labor, ntgtedals, and eqOomnt needed to complete the work, whether actualy paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING• HEAT SOURCE: Gas IVElectric ❑Other BUILDING TYPE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all t t apply) : ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable a -roof ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure ❑Fence over 7ft high ❑R cckStorage Po I/Hot Tub ❑Tank (above ground) ❑Other: DESCRIP N O Q V Cd O � N ` ' �rY re, fa K Q� V 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 1 am authorized by the owner of this property to perform the work for which application Is made, and I comply with the State Contractors La5Oq7 RC and 296.200 AC. _ _ A _ City of Everett Official Use Only PERMIT # _ �-A��' I()0a� Owner/Authorized Agent Signature D to (Revised 21812021)