916 105TH PL SE 2023-08-01 - Laserfiche WebLink

LizL BOLDING 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)PermitServices@everettwa.gov I(VV)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 916 105th PI SE PARCEL#: 00397000003910 clry Everett STATE WA ZIP 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: BROADWAY FARMS NO2 BLK 000 0-10 Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Linda Evans OWNER MAILING ADDRESS: STREET 916 105th PI SE CITY Everett STATE WA ZIP 98208 OWNER PHONE:(425)290-5588 OWNER EMAIL: lindarayevans@comcast.net CONTRACTOR COMPANY NAME:Matvey Foundation Repair ,1/1,k'1 1/E fic g '71 `j WA STATE CONTRACTOR LICENSE#(REQUIRED):' e694jb CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 056264 CONTRACTOR ADDRESS: STREET 18915 16th Ave S CITY Seatac STATE Wa zip 98188 CONTRACTOR PHONE:(253)327-1650 CONTRACTOR EMAIL:permits@gomatvey.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(206)698-3799 C i e rra Pinson CONTACT EMAIL:permits@gomatvey.com BUILDING INFORMATION VALUATION OF WORK:$12500 ASSOCIATED LAND USE PROJECT#(if applicable):permits@gomatvey.com (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:SFR PROPOSED USE OF BUILDING:No Change HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: iSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑✓Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ElTank(above ground) ❑Other: DESCRIPTION OF WORK: D ECEIWE Underpinning Existing Family Residence � FEB 1 1 2023 JJ CITY OF EVL ETT Permit Services 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 WAG. City of Everett Official Use Only eie./2.2a- /"l. b� 02/06/2023 PERMIT# Owner/Authorized Agent Signature Date (Revised 4/21/2022) T C i,,