10025 9TH AVE W 2023-07-28 - Laserfiche WebLink

BU G PERMIT ILDIN R IT APPLICATI.,1 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 10025 9th Ave.W. PARCEL#: 00905000210200 cln. Everett STATE WA ZIP 98204 SUITE/UNIT#: Bldg.B,Unit 102 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: See Attached Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Emerald Gardens HOA- Stan Kuligoski (Port Gardner Property Management) OWNER MAILING ADDRESS: STREET P.O. Box 1007 CITY Everett STATE WA ZIP 98206 OWNER PHONE:425-339-1160 OWNER EMAIL: Stan @ portgardnermgmt.com CONTRACTOR COMPANY NAME:McLeod Construction - Steve Hardy WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 1 115 N. 140th St. my Seattle STATE WA ZIP 98133 CONTRACTOR PHONE:206-574-8706 CONTRACTOR EMAIL:steve @ mcleodconstruction.com PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Agent for Owner CONTACT NAME: CONTACT PHONE:206-281-7500 Chris Bacus-Pacific Engineering Tech. CONTACT EMAIL:obacus@pacengtech.com BUILDING INFORMATION VALUATION OF WORK: $30,000 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:Condominiums (Residential) PROPOSED USE OF BUILDING:No Change HEAT SOURCE: ❑Gas ✓❑Electric ❑Other BUILDING TYPE: ❑SFR ETownhouse ❑Duplex ❑ADU ©Multi-Family-#Units: 4 ❑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: See Attached 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 4/3/22 PERMIllO�—D'w Owner/Authorized Agent Signature Date (Revised 4/21/2022) v ��