11021 1ST AVE SE 2023-05-22 - Laserfiche WebLink

• MEI BUILDING PERMIT APPLICATIc 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1 1021 1st Ave SE PARCEL#: 00391500001600 cl-r Everett STATE WA ZIP 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Bergs Add Lot No: 16 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:JOSe & Paula De Cruz OWNER MAILING ADDRESS: STREET 11021 1st Ave SE cln, Everett STATE WA ZIP 98208 OWNER PHONE:206-830-0631 OWNER EMAIL: ablcmjm©gmail.com CONTRACTOR COMPANY NAME:TBD WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Designer CONTACT NAME: CONTACT PHONE:(425)444-3385 JT of JT Design CONTACT EmAiLjt_design@comcast.net COmCast.net BUILDING INFORMATION VALUATION OF WORK:$35,000 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of at labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: Single Family PROPOSED USE OF BUILDING: Single Family 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 ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑ExteriorAlteration ❑Tank(above ground) ❑✓Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:replace deck&add covered deck DESCRIPTION OF WORK:Take out existing deck and replace that portion with a new roof over, then extend deck to house on 2 sides 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC City of Everett Official Use Only Dgitally signed by John Trepidpa John TregidgaR�eUsa - ;o, ahnreqdpa E-,l�rey,tle=g eom 4/29 PERMIT22.� wwaon:rou g reIwaeon Here Dat 202200.2911 2621-0T00' Foxii GOF Reatler Version:11.2.1 Owner/Authorized Agent Signature Date (Revised 4/21/2022)