2415 11TH ST 2023-07-31 - Laserfiche WebLink

11111111 BUILDING 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)425.257.88101(E)everetteps©everettwa.gov((W)everettwa.gov/permits (Blue or Black Mk Only Please) PROJECT SiTE INFORMATION PROJECT SITE ADDRESS: STREET 7 ! 15 . } I • '' POO- PARCEL#: criY 4.c.✓�J l.}� 11 STATE LLi ket- ZIP Cit& SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable): TENANTBUSiNESS NAME(if non-residential): 1' -c O" < LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A L..S ( A i4.14Soot- Owm4 4, OWNER MAILING ADDRESS: STREET ro . a x 6 3 q,j O CID(�i-�t h:' Z STATE CA- ZIP q-Z-l`►? 2— OWNER R PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:F&i d S LF (3 t C .t^'/C.- - WA STATE CONTRACTOR LICENSE#(REQUIRED):'i (C)D.M S d i 40 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET G 5 Z A7 7 ell? - r• s > cr V�sz.' 'j STATE `"J t7 ZIP 1 /�"3G.- CONTRACTOR PHONE: 1.73 " gj z ''4174 CONTRACTOR EMAIL: ( v} p Ce4 pi,AasicovF S tii+" '- tche t PRIMARY CONTACT: ❑OWNER AONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Z,53 — 7 7 -/ 1741/ CONTACT EMAIL: ,' 1 (�� j c..0 i P Se,ig1re e •C(.141, BUILDING INFORMATION VALUATION OF WORK:$ 3 7 7 0(7 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair mafket value of ail labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: 114IM 1r'D�+'+ l - PROPOSED USE OF BUILDING: ' 1 Ho'L�f`11/ , HEAT SOURCE: OGas -Electric OOther BUILDING TYPE: OSFR OTownhouse ODuplex DADU -#Units: DCommerciai DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction DAddition ORemodel DRepair DT.1. OChange of Use DModular DPortable e-roof DExterior Alteration OTank(above ground) OAccessory Structure OFence over 7ft high ORackStorage OPool/Hot Tub OTank(above ground) OOther: DESCRIPTION OF WORK P o L vet2 L ( t[� 6 04.kel Old t r►f ( � i3 cnr2 ACKNOWLEDGEMENT.:!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.t 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# p j I O7— O n.w,nrlA..ihe,rbuti Anent Signature Date (Revised 2/8/2021) /Z