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

• • E BUILDING PERMIT APPLICATION EVERETT CiTY OF EVERETT PERMIT SERVICES 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 `I I S )i " tom- ckj,1 I„s ( PARCEL#: CITY fvEcP_-4F • STATE WA ZIP g9)dt SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): VG,r c 60 ) IL." LEGAL DESCRiPT{ON for new construction: Short Plat/subdivision: ' Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A L 4,t^Xc, e C OW AO C L.I.C.- OWNER MAILING ADDRESS: STREET 6 3 07z 5 ('h e c•S C 1...A1 hkc W3v CiTY C e.n-4 e ri A,h l. STATE Ca ZIP OWNER PHONE: (OWNER EMAIL: CONTRACTOR COMPANY NAME: S 4 y Iri h.)-e( WA STATE CONTRACTOR LICENSE#(REQUIRED): `js 5i ki L 3.)L. i ICTTY OF EVERETT BUSINESS LICENSE A :#f REQUIRED ( ) eCeier ..14.2l CONTRACTOR ADDRESS: STREET 13 t i P61,-5‘„„+,,n St cm( q )e A,,,)r;h STATE VA" ZIP a A 3/q CONTRACTOR PHONE: 703-(-17,--2 6 ie 'CONTRACTOR EMAIL: C ,.• - _...._,. e--•._ ....3_ ._,`..S e I",c,+e(...'C a.M PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 7a3- '17 a- 9,6l4? C i l f“, 1\16144 n CONTACT EMAIL: 6 nel 40^c _54 SP.- c,c o' BUILDING INFORMATION VALUATION OF WORK:$ 3 6 ovb 'ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair markefvalue of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: A`'u r-1 M e�k PROPOSED USE OF BUILDING: Nv C\A a,..st HEAT SOURCE: ❑Gas r&lectric (]Other BUILDING TYPE: ❑SFR OTownhouse ODuplex OADU Multi-Family-#Units: 30 OCommercial OAccessoryStructure TYPE OF PROJECT(check all that apply): ONew Construction OAddition ORemcdel iiiRepair OT.I. OChange of Use OModular OPortable ORe-roof OExterior Alteration OTank(above ground) OAccessory Structure • OFence over 7ft high ❑RackStorage OPool/Hot Tub OTank(above ground) OOther: DESCRIPTION OF WORK: �� L Z ri oUI n 1 '2 J1"eeJ-coct= -To aCCe44 kor--V.1,J, Q.-3,-ck";rw . wt;IAki k? ,` 1 y to X. 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 PERMIT# �P.csfi„ to/�/21 13 2 I I Z - 0 2-1- 7wner/Authorized Agent Signature Date (Revised 2/8/2021)