815 108TH PL SE 2023-06-29 - Laserfiche WebLink

in BIDING 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 "IS 1(i tSTF{ f i-. SC PARCEL#: D;Q 1'2.'2 0f>f%C Cjib CtrY EV f=&l'-:IT STATE kiVA ZIP 9 SUITE/UNIT#: 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) `'1N�11 CONTACT INFORMATION OWNER NAME: Kj L V SA F Lc 1 OWNER MAILING ADDRESS: STREET qy5 logtti Pt_ .c: crrY c V F-Re.IT STATE WA-- ZIP 9ncg OWNER PHONE: ,2.5'337 - .2oGCJ OWNER EMAIL: 41V IV1 Scif ICire_yaiipG,C C(Yt. CONTRACTOR COMPANY NAME: ()N ry E Ka WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: EIOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: ( `'J j 5 �-0K CONTACT PHONE: t.�2\r r- 'i -2_60C� � l- CONTACT EMAIL: r&'IY)_s of ita -9CA(2a) BUILDING INFORMATION VALUATION OF WORK:$ •,S %C' 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: rgl MA 'i R c C tJ C PROPOSED USE OF BUILDING: `(1F",5I OE NTi At- HEAT SOURCE: LJGas ❑Electric ❑Other BUILDING TYPE: C t'SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction L Addition ❑Remodel ❑Repair ❑T.l. ❑Change of Use ❑Modular ❑Portable LIRe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: P(C C (X at 'Cl-ciI C C Ct'$e/ DESCRIPTION OF WORK: O ciiiaC 1 . h 7 n�,i,jt€ii1 Spiral '(rc t o @ic.`tsciti9 d , �1Yfe 1e)� Oro i rJtCK ito growl d lc log 'males i width ;s W-b 'wtche.s 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 i�1V -SA�L` i,/��Qz PERMIT# 2201. 0� Oi 42 Owner/Authorized Agent Signature Date (Revised 4/21 2022) l(� i 2