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BOLDING PERMIT APPLICATIMN <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 5301 33rd Ave W. PARCEL #: <br />crry Everett STATE WA Z,P 98203 <br />SUITE/UNIT #: FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Mark Swenson, Victoria Postma <br />OWNER MAILING ADDRESS: STREET 5301 33rd Ave W. <br />,I y Everett STATE WA Z,p 98203 <br />OWNER PHONE:425-876-3500 IOWNER <br />EMAIL: VLPOSTMA@gmall.com <br />CONTRACTOR COMPANY NAME: VanderBeken Remodel <br />WA STATE CONTRACTOR LICENSE #(REQUIRED):VAN DER*81 1 RD <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 55051 <br />CONTRACTOR ADDRESS: STREET306 State Ave <br />CITY Marysville STATE WA ZIP 98270 <br />CONTRACTOR PHONE:425-408-2224 <br />1CONTRACTOR EMAIL:Jason@vanderbeken-remodel.com <br />PRIMARY CONTACT: ❑ OWNER ❑✓ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Jason Taylor <br />CONTACT PHONE:425-408-2224 <br />CONTACTEMAIL:jason@vanderbeken-remodel.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $1 19,264.17 ASSOCIATED LAND USE PROJECT # (if applicable): <br />(Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) <br />EXISTING USE OF BUILDING:Single Family Residence <br />PROPOSED USE OF BUILDING:Single Family Residence <br />HEAT SOURCE: ❑Gas WElectric []Other <br />BUILDING TYPE: ❑✓ SFR ❑Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑✓ Remodel ❑Repair ❑T.I. ❑Change of Use <br />❑Modular ❑Portable ❑Re -roof El Exterior Alteration ❑Tank (above ground) ❑Accessory Structure <br />❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other: <br />DESCRIPTION OF WORK: Demo of Sheetorck in Kitchen/Dining Room, Removal of 3 Interior Walls, Interior <br />Frame 2 walls, Remove 3 windows, Replace 2 existing windows with smaller windows, <br />re -finish hardwood floors, Install new cabinets and appliances. <br />**Roof is Truss Framed, field verified no mid -span loads on interior walls <br />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 <br />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 <br />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, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # 13 <br />(Revised 412112022) 7 <br />