2119 LOMBARD AVE 2023-05-30 - Laserfiche WebLink

mos im BOLDING PERMIT APPLICAWN EVERETT CITY OF EVERETT RVICES SUBMITTAL INSTRUCTIONS: See applicable submittal checklistPERMITSE 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 2119 Lombard Ave PARCEL#: 00439143901000 Crry Everett STATE Washington ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: 10 & 11 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:IDwayne Youngblut Kasidee Youngblut OWNER MAILING ADDRESS: STREET 2119 Lombard Ave CITY Everett STATE Washington ZIP 98201 OWNER PHONE:42538775588 OWNER EMAIL: dmyoungblut@gmail.com CONTRACTOR COMPANY NAME:Ilr10vative touch IIc WA STATE CONTRACTOR LICENSE#(REQUIRED):INNOVTL81 20T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET3502 Broadway CITY Everett STATE Washington ZIP 98201 CONTRACTOR PHONE:425760421 6 CONTRACTOR EMAIL:Info@thelnnovativetouch.com PRIMARY CONTACT: ❑ OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4257604216 Kyle Cook CONTACT EMAIL:info@theinnovativetouch.com BUILDING INFORMATION VALUATION OF WORK: $252,770 ASSOCIATED LAND USE PROJECT#(if applicable): (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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ✓❑SFR ❑Townhouse ❑Duplex EADU ❑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 ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: 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. i 4 City of Everett Official Use Only �!} } , R },, �0�/ 1 PERMIT#82103-087 �u/'C1.[art.L -m. �-�Gl.��.�,.E�.CGc�. r'�...IiI.SIU'�t �. �o�'lt v 9 Ul�i Owner/Authorized'AgenjttOl Signature Date (Revised 4/21/2022)