1206 58TH ST SW 2023-08-08 - Laserfiche WebLink

MG 111,111 BUlibING PERMIT APPLICATAN E©EOV17' CITY OF EVERETT PERMIT SERVICES I "'• .. r,;? ,) 1 ^. ^?. !' ` E VE R E T T SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and nu,i fiber of Copies required for review, WASHINGTON then Crop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-8810((E)PermitServices@everettwa.gov l e rea.@i _i (Bills.nr Brack Ink Only Masse PROJECT SITE INFORMATION TION permit Services PROJECT SITE ADDRESS: STREET Ir.�©� • �t S'Gt1 PARCEL#:CD(.3( R/OO 8 /6 / (, CITY /-:- WAX a/ STATE f/CA ZIP / ga3 SUITE/UNIT#: )( 4)e 34 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): N, TENANT/BUSINESS NAME(if non-residential): AIM LEGAL DESCRIPTION for new construction: Short Plat/subdivision: /..if/a Lot No.: AWL (attach copy of long Legal description) •s" I -------_-_._. _ CONTACT INFORMATION - � --- OWNER NAME: Sc.bree ( ,�jmmi.uniIzt. ilioA OWNER MAILING ADDRESS: smear q0`7j L j-I-e j t-t £2 t-t- . /� crry E v CG STATE WA ZIP 9 8a6 OWNER PHONE: OWNER EMAIL: MS v.Ja. r1en / Di s& .Liam 1CONTRACTOR OR COMPANY NAME: i im-A i s.. r r ° #WA STATE CONTRACTOR LICENSE#(REQUIRED):QrVL2 eL N21351cITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6,9 4.DorP) I CONTRACTOR ADDRESS: STREET Ina-5(Li Ash 40.4, /� y CITY Ir'j,I�'VJ t 11-e STATE idui' ZIP ei,r,�c 11.5 • CONTRACTOR PHONE: /2 5-ei 8 5 2.S,2 CONTRACTOR EMAIL: )it'I U.e.r.ad e 2 00,6 nc1 t C-c .fa171 PRIMARY CONTACT: CI OWNER CONTRACTOR 0 OTHER(Please Specify) 1CONTACT\ NAME:I ! r r l((,� !CONTACT PHONE: L1('25_ q(�1-8 02 r5Q I \A -/� �.n ( n:nf • t, '/ ill de '� l—o6 S [`t,ix -c-vtSi,I Ir-v �� 1CONrACT EMAIL: ` 1'C✓' N iYxt%6ide 'I"Gbl-,t t /lc.ccin 1 BUILDING INFORMATION VALUATION OF WORK:$ 71 1175. 0() ASSOCIATED LAND USE PROJECT#(if applicable): A J/Q (Valuation shall include the prevailing fair market value of all tabor,materials,and equipment needed to complete the work,whether actually paid or not) EXISTING USE or BUILDING: 'Mir p.-1-; - Lyn"; L,4 — azIncloc. 'PROPOSED USE OF BUILDING: Intl-1-j - Peuyl(-IAA? e' )r7� HEAT SOURCE: L~1Uas L^.ir lecrnc umber '' BUILDING TYPE: DSFR ❑Townhouse ❑Duplex DADUAlulti-Family-#Units: A ❑Commercial DAccessory Structure •Ifi+E OF PROJECT(check all that apply): [(New Construction DAddition ❑Remodel ❑Repair OT.I. !]Change of Use ❑Modular DPorteble e-roof [:Exterior Alteration [Tank(above ground) DAccessory Structure ° DFe'nos over i ft high ORa kStorage ❑PoollHot Tub Drank(above ground) ❑ trier:__ 'DESCRIPTION OF WORK: 1<-&n?4 allot ft pe4-i-c-e_ ,,t1LSS4-n 4. 1 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 f am authorized by the owner of this properly to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW end 296.200A WAC. City of Everett Official Use Only ffI /) PERMIT# Owner/Authorized Anent Signature Date Revised 4/2ii2u221