5731 12TH AVE W 2023-07-31 - Laserfiche WebLink

1.) L. -,'‘'EOVErr am i.� BING PERMIT APPLICATIA APR 2 1 2023 LI `■1° CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements anA(n t n�berr of�cop�--te,s,,�rre wired for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 at Jtr d.Il6&h thk cop Box. CONTACT INFORMATION:(P)425-257-8810)(E)PermitServices@everettwa,gov I(W)Revr Lit S (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: �. '7 a 1 /2 t L-.4L' `` t PARCEL `.00O C2i, B f OOP/b o/1 �� c. .a v �. .a. STREETS J L PA....�� Fr- 4/ I y r vv CITY I t9 STATE C, tA- ZIP q IJ SUITE/UNIT#: )L.1 C FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): NIA, TENANT/BUSINESS NAME(if non-residential): kj J&. LEGAL DESCRIPTION for new construction: Short Plat/subdivision: aftrkLot No.: N/A, (attach copy of long legal description) CONTACT INFORMATION 'OWNER NAME: �_C,5 ]+'1 •t.L r . •e &nl In i.t.n1 chi S4L74 e OWNER matt mu; r7 nRRFSfi STREET 9qn`7 l401 t! A.i O. I Cm' E—/. .lie STATE t0�` ZIP 9 g2t9/ OWNER PHONE: IIJJ��/--��'" OWNER EMAIL: ins bo ebrYen 1(s) 5/) C d m CONTRACTOR COMPANY NAME: ii,A.,e44,CA_p /2oori rl. L-L-/- iriA STATE CONTR C T'M! TOR LICENSE#(REQUIRED):#7E r I.,E e i a 24-re OF EVERETT BUSINESS LICENSE#(REQUIRED): /e h A a 'CONTRACTOR ADDRESS: STREET 5 I LT Ash A CITY G) -DA t� f� - STATE )i • GJ ZIP 9 a"7(✓ CONTRACTOR PHONE: 426-9 -`(8 a CONTRACTOR EMAIL: CYoric rl v-e r..`el e y 0o{Sty fie- -e. //? PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: italit CONTACT PHONE: 4 2l-_ei ct ei—g gsa { , c I r Vr✓l. • �� � CONTACT EMAIL'. CJ 6 I)Le Lille (C/O�/ t /(c'e��)/® 66 � I BUILDING INFORMATION I VALUATION OF WORK:$ ,9 1 q"50.00 ASSOCIATED LAND USE PROJECT#(if applicable): A)jk (Valuation shalt include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not) I EXISTING USE OF BUILDING: ` n i,LQ t _Lt..071.4 II- ei.„fo0f, PROPOSED USE OF BUILDING: ,`4}1 tali -Path(CA — Crimp s 'HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 'Alai-Family-#Units: i,9 ❑Commercial DAccessory Structure I1 TYPE OF PROJECT(check all that apply): ❑New Construction DAddition ❑Remodel DRepair ❑T.I. ❑Change of Use ❑Modular ❑Portable Re-roof DExterior Alteration ❑Tank(above ground) DAccessory Structure ❑Fence over 7ft high ❑RackStorage LiPool/Hot Tub LITank(above ground) DOther: DESCRIPTION OF WORK: 1 --Rem a a_,Y of JuLtp Lilt .. G4 5'kr ACKNOWLEDGEMENT:I have eviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must compf,with current federal.state,and local lair.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 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with the C1ate Contractors Law iR 77 RCW and 7116.7021 W4C City of Everett orticiel Use Only PERMIT.# (; P Owner/Authorized Agent Signature Date (Rovised 4121i2022)v