2215 LOMBARD AVE 2023-06-22 - Laserfiche WebLink

DocuSign Envelope ID:B0074E5A-E1C1-4417-9217-775F1334AC39 Blii•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 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 2215 Lombard Ave PARCEL#: 00439147500700 crry Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: EVERETT PLAT OF BLK 475 D-00 Lot No.: 7&8 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Gregory Smead OWNER MAILING ADDRESS: STREET 2215 Lombard Ave CITY Everett STATE WA ZIP 98201 OWNER PHONE: 425-876-7806 OWNER EMAIL: CONTRACTOR COMPANY NAME: Ram Jack West WA STATE CONTRACTOR LICENSE#(REQUIRED): RAMJAW852PW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6-7 5 1.-7 CONTRACTOR ADDRESS: STREET PO Box 11701 CITY Eugene STATE OR Zip 97440 CONTRACTOR PHONE: 541-510-9079 CONTRACTOR EMAIL: permits@ramjackwest.com PRIMARY CONTACT: ❑OWNER CONTRACTOR El OTHER(Please Specify) CONTACT NAME: Kelsea Rossow CONTACT PHONE: 541-510-9079 Ram Jack West CONTACT EMAIL: permits@ramjackwest.com BUILDING INFORMATION VALUATION OF WORK:$ 17210 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: Single family residence PROPOSED USE OF BUILDING: No change HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE:x®SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel xSJRepair ❑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: Voluntary repair to the existing foundation of the home 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 1 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 1—DocuSlgned by: PERMIT#KKarst* Kiwox, 1/5/2023 0 3 0 — OwnerfAuthodzempetAigwure Date (Revised 4/21/2022) (j