3416 ROCKEFELLER AVE 2023-06-30 - Laserfiche WebLink

B&DING 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 submittaldocuments 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 (Bide or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET A16Lc4slillerAve PARCEL M 001- 5(ol e, CITY WE t 1 STATE WA ZIP Ct 0I SUITE/UNIT M 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: kolkibocV, NA j( UST OWNER MAILING ADDRESS: STREET O CITY STATE WA ZIP 'T.W OWNER PHONE: 01 S" y —g(TOU S,. OWWNER EMAIL: , `r® CONTRACTOR COMPANY NAME: Wes .i1 woo 1,{.i ! ers L� WA STATE CONTRACTOR LICENSE #(REQUIRED): 6.k) S ®a CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET ag3o make- r. CITY 1,qe, e r< STATE ZIP l r�-5_1 CONTRACTOR PHONE: CONTRACTOR EMAIL: We.9,tu90Cj6L.( lo�eiP.i /hct IY• PRIMARY CONTACT: [N OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: r 0 BUILDING INFORMATION VALUATION OF WORK: $ 600 JASSOCIATED LAND USE PROJECT # (if applicable): (Valuation shall include the prevailing fair _rtfarket value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: %SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition Wemodel ❑Repair ❑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: (� %iseolet.1i ex*,fllh' ulo�`IS I ao(c AMvn� bedVe� j �-�t�ls ut�f►wl� IQb�i ePtIGd" fu r Y► GO+sC'��oP.e-✓ y aA4 are, Lo iyidD tJ yn6e-+' ` i MR-zl ex'(Z3S' tw'siW 6 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 I am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Laws& RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # lv o� zo- 2 wne Agent Sig ature D afe (Revised M12029) 1oN' va