4512 FOREST DR 2023-04-06 - Laserfiche WebLink

• MO 11. 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 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4 5 1�, j�re�(Lc4' V'O'Ihe/ PARCEL#:� / lea /J CITY C/t),evt STATE WA ZIP lea 2 03 SUITE/UNIT#: 41t7 IA$g FLOOR#: . 1 ADDITIONAL LOCATION INFORMATION (if applicable): 7 TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION , OWNER NAME: OULY avio� `5 ift & -a1-e Ckd/l1Pc k OWNER MAILING ADDRESS: STREET 2 151, 114 U,le L'+-e_0 'IVA CITY 5v eve if STATE tA/A. ZIP 1 ) 20 3 OWNER PHONE: 4-2 5- 75 2.--04- 1 3 OWNER EMAIL: 001 C- Qa/eveta as( . 0V'l' CONTRACTOR COMPANY NAME: 6-D Z F�M O cep I Lk,C - J WA STATE CONTRACTOR LICENSE#(REQUIRED):E,DZR E _% JCTf OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 5O '3 CONTRACTOR ADDRESS: STREET a 2.2. 0 ril Ot,V`mo et r c„, .w 0./CITY A r 1 ng / A STATE t04 c H {ZIP 8 2.23 CONTRACTOR PHONE: 360 `6 31 - f;t 73 V CONTRACTOR EMAIL: 1 } 1.,.,,, PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 'OTHER(Please Specify) G49t/I V(JVt 14 l ) p e(l t e r. CONTACT NAME: CONTACT PHONE: 4 z "f/0r J5 _ S 2.14-9-V MiCHAEI/ t 1I*Ol, , t6ikIilk CONTACT EMAIL: IAA bar 10l24IIC� nliV1AtI. doi'1/t BUILDING INFORMATION VALUATION OF WORK:$ 101 Gee, ASSOCIATED LAND USE PROJECT#(if applicable): 14 Zeit (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: 5'Iif p1ei 1Y1 1 I I VW" LMe, PROPOSED USE OF BUILDING: frA e- HEAT SOURCE: ❑Gas lectric ❑Other BUILDING TYPE: 6ISFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ....�� ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition LH'�emodel IloRepair ❑T.I. ❑Change of Use ❑Modular ❑Portable El Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: I ►Mode( ..ex 1 6--4 too vn • favr® N- J Pry+w�dl -Pr/v)(�I% i�vW, 14n, . to 1,I a cg Aec - 4tU U r$. ACKNOWLEDG ENT.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 ma and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# _ , Tvt,._Alt,-...la e__ Owner/Authorized Agent Signature Date (Revised 4/21/2022) s re 1 O(,-r 5e v(6r� (I,i. -c-a..1. CI LLB t yz..,