9103 5TH PL W A & B 2023-07-28 - Laserfiche WebLink

NNE B•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)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4103 57 PL j PARCEL#: OO 'j3I, ' 000 -OI, "00 CITY EVERE STATE W ZIP � Unit SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision:Mil DOWS BLL 000 P — LOT gjattach copy of long legal description) _ CONTACT INFORMATION OWNER NAME: 10gy E. 1.11t18 OWNER MAILING ADDRESS: STREET '1 D3 j c PL W *5 (�/�J� CITY lid�!�✓lf STATE 1'0 ZIP 1O2V 11- OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: b L OI2 PPOPeT PES 7TO 1TIOk WA STATE CONTRACTOR LICENSE#(REQUIRED):n, ff0 LN a 110 0- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): '9 CONTRACTOR ADDRESS: STREET $C320 'Skint 13W PUKE SLI f 1 I00 CITY h & f 1fl.� . STATE 'Ae i ZIP igibg/ CONTRACTOR PHONE: (20) 3ng 513 CONTRACTOR EMAIL:dyes.serres0 us. belfor. com PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR Ii0THER(Please Specify) f- C(tIRlL -NAINEEF- CONTACT NAME: ,I f� CONTACT PHONE: ON) *cI I. biA tel"fr E. CE1 CONTACT EMAIL: xmq f$(S® clectenkkhorn BUILDING INFORMATION VALUATION OF WORK: $ Lr<1 5,000 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: ID NTICIL- Nf LeX PROPOSED USE OF BUILDING: Zia. - puna 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 ❑ 11Addition ❑Remodel L�JRepair ❑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: I3UILDIt'J IS II' o 1 'Srvc'f ivooD fKfMED puflLei.• 11 'FIDE P6F-44 -- VAN rizeD vN SST sivE or -OW- KFSIDENce. MOVE fkNO l�'t-p - (2cOof -(Asses ors ooltt vifstirs , PAD E D t4PC61 D INEA, pc-ti[NG- UIsK i -iNND "IA-rEWflI,S it wow- pt+1e b(ev o0 ry o N - 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.1 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 IIP3U i� 1 PERMIT# 2-( o J) I Own uthorized Agent Signature Date (Revised 2/8/2021) I/ Z