3217 54TH ST SW 2023-07-31 - Laserfiche WebLink

• • aro 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)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.govlpermits (Blue or Black ink Only Please) PROJECT SITE INFORMATIONC PROJECT SITE ADDRESS: STREET 2. (`1- S-41 s�ii- ) PARCEL#:0 C JI I010 0*39 C CITY- �../e.1/1.,. STATE 4- ZIP 7'J 2' ''/ SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(If non-residential): LEGAL DESCRIPTION for new construction: Short Platlsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: A A c.,vw1 T3��J-.. Is v ` IP ..t . OWNER MAILING ADDRESS: STREET 32.\"1- c L-1. t Si- 5 u' CITY d(-4' -k\ D,STATE tom`It ZIP ZIP 9 K �t-: OWNER PHONE: •2== ` 8�"I ,� R {OWNER EMAIL: G'i r c�wi^�w IQ i („.i!c_ - G jl,,,,c,,1 ` i/Sl"`II CONTRACTOR COMPANY NAME: 4INA i - r".' I l_tl. -v c-t.c -a-,-- Q wi r-r.c .J G c `t61... CifY OF EVE,RETT BUSINESS LICENSE#(REQUIRED): (tj 1' CC WA STATE CONTRACTOR LICENSE#(REQUIRED):t�� (�E i� G.C.W � J CONTRACTOR ADDRESS: STREET G4 `k'2i :f ,. +} � CCVS 1 v " `D ^`' �{/�_ q errY ev 'i' `, STATE V3 i 7 ZIP ��,�``9 g 2-0 CONTRACTOR PHONE: iT�s ? }'$ 1 S 1 CONTRACTOR EMAIL: d m �`,L cj IV 3 e_ In�c';1 Cowl PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) {f CONTACT NAM : CONTACT PHONE: Li Z C1c 1-- \94' 1m.\C...Y`G<- V‘v 1. c V-) CONTACT EMAIL: a w c)(y LL/'e_t 1 Co 1 al I;,t 1 i (Pit/ BUILDING INFORMATION VALUATION OF WORK:$ "-ZS`dab l cA 1ASSOCIATED 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: TC) , c- --4,,JJ4- PROPOSED USE OF BUILDING: (C S c T` `'- HEAT SOURCE: CI Gas ❑Electric DOther BUILDING TYPE: .SFR DTownhouse DDuplex ❑ADU ❑Multi-Family-#Units: DCommercial DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction DAddition Remodel Li Repair DT.I. ❑Change of Use ❑Modular DPortable ❑Re-roof ❑Exterior Alteration DTank(above ground) DAccessory Structure OFence over 7ft high DRackStorage DPool/Hot Tub LTank(above ground) DOther: DESCRIPTION OF WORK: S el, ?rtM at l cutaatj : i4 e w O v)a.,U.- 1 r, \o 0 H't rncts l-e-Ir Ci vwt to it,+-k. Ref l tl i rti (Mir rt41} IA)'lnalvin)s ix A.f"DfS va On DLO. Revvto mkt 1 liu, ba,N,vrvonn v l/' oh in utAmic oorva n' i-t.. WA'.r e n k p\t.u'n b i i9 tO ne IA) t(oc u,-i a s , s oWt.e. P.l c(Ah'i(id t i 1,l ke ota in e as tn)e.A l. ACKNOWLEDGEMENT:I have reviewed this application and confine 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 lam the owner,or i am authorized by the owner of this property to perform the work for which application is made. and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only )Ai ' c \UC /C------\ Owner/Authorized Agent Signa ure Da 1 (Revised 2/8/2021) i/Z