10110 19TH AVE SE 2023-06-23 - Laserfiche WebLink

ALDING PERMIT APPLICATI 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 10110 19th Avenue Southwest PARCEL#: 28051900100200 CITY Everett STATE WA zip 98208 SUITE/UNIT#: E 104-204-304 FLOOR#: 1-2-3 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Mercy Housing LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Family Tree&Lincoln LLLP OWNER MAILING ADDRESS: STREET 6930 Martin Luther King Way CITY Seattle STATE WA ZIP 98112 OWNER PHONE:206-898-6932 OWNER EMAIL: gswendrak@mercyhousing.org CONTRACTOR COMPANY NAME: Interstate Restoration Iv i Te (7, R(/\J (1 S 13 ti WA STATE CONTRACTOR LICENSE#(REQUIRED):602846667 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 55636 CONTRACTOR ADDRESS: sTREET22342 68th Ave s CITY Kent STATE WA ZIP 98023 CONTRACTOR PHONE:369-349-6579 CONTRACTOR EMAIL:Mike.Bergman@firstonsite.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-349-6579 Mike Bergman CONTACT EMAIL:mike.bergman@firstonsite.com BUILDING INFORMATION VALUATION OF WORK:$9000.00 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:mUlti-Family PROPOSED USE OF BUILDING:MUlti-Family HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex LIADU ❑✓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) ElAccessory Structure ❑Fence over 7ft high ❑RackStorage ElPool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:Repalce Insulation and Drywall in 3 listed units Due to water lose. No alterations • 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 PERMIT# /02 -5 - col. Owner/Authorized Agent iiipt re Date (Revised 4/21/2022) ,a z