3625 HOYT AVE 2023-04-07 - Laserfiche WebLink

BUING PERMIT APPLICATIO 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 3(.00 5 PARCEL#: CITY [Nigro AA- STATE ZIP 9 9 03 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Akocip TENANT/BUSINESS NAME(if non-residential): C Lan 17—VG LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: C! \cSS OWNER MAILING ADDRESS: STREET I-4 CITY Q�Y Q �'�'"' STATE �P ZIP 9,g p)0 3 OWNER PHONE: 5- I�R, py VC:o OWNER EMAILT\ .v v-f '), , LDca- aCiID1/' avy.)h,o , t CONTRACTOR COMPANY NAME: CA xy WA STATE CONTRACTOR LICENSE#(REQUIRED) C '9wvVIB 4F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Di 18 I CONTRACTOR ADDRESS: STREET \5c Y)c)c (:;0 I'�`JQs.1,e , CITY Y".Oh, . STATE ZIP q 2a',0 CONTRACTOR PHONE: .�Vio -8 -( i'1O5 CONTRACTOR EMAIL: rb' eri e (\up Cone., PRIMARY CONTACT: ❑OWNER kf CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L5 - 003- 3&; 'C \-6 �� CONTACT EMAIL: Y'•ma\si(( C► 1(�M vim' �r�y1 BUILDING INFORMATION VALUATION OF WORK:$ LA50 ()�®, �(� ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair markettvalue of all labor Ihatteenals,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: , cv-Nt\1 PROPOSED USE OF BUILDING: (Yt� HEAT SOURCE: ❑Gas ®Electric ❑Other BUILDING TYPE: OSFR ❑Townhouse ❑Duplex ❑ADU NMulti-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel MRepair CT.!. ❑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: F DESCRIPTION 54rfNUO OVA` , K CS( eQ,daejb11\12,44- `%o maied W°c d d/ 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 l am authorized by the owner of this property to perform the work for which application is made, and I-comply with the State Contractors-Law 18.27 RCW and 296.200A-WAC. City of Everett Official Use Only ( --2 27-0 — 0 05 (l I �p� PERMIT# OJvne u orized Agent S •t (!�re I Date (Revised 4/21/2022)