620 112TH ST SE SPACE 193 2023-08-01

BDING PERMIT APPLICATlION E V E R E T T CITY OF EVERETT PERMIT SERVICES 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(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 620 112th St SE PARCEL#: cln, Everett STATE WA ZIP SUITE/UNIT#: 193 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):Mobile Home Park TENANT/BUSINESS NAME(if non-residential):Lago De Plata Villa LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Lago De Plata Villa LLC OWNER MAILING ADDRESS: STREET 7426 SE 27th St. Suite 2B c,n Mercer Island STATE WA ZIP 98040 OWNER PHONE:425-941-8422 OWNER EMAIL: julie@patinarealestate.com CONTRACTOR COMPANY NAME:Rainier Structures LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):RAIN IS*883CG CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CI t 7 CONTRACTOR ADDRESS: STREET7426 SE 27th St. Suite 2B c,n Mercer Island STATE WA zip 98040 CONTRACTOR PHONE:425-281-6626 { ONTRACTOR EMAIL:chadgeorgell@gmail.com PRIMARY CONTACT: ❑ OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-281-6626 Chad G eo rg e I I CONTACT EMAIL:chadgeorgell@gmail.com BUILDING INFORMATION VALUATION OF WORK: $20,000 ASSOCIATED 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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑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 ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: Installation of a new Manufactured home into existing spot in manufacturedh m home park (lago de plata villa) where utilities are already current from previous home unit. 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Chad Georpell 1-20 23 r Owner/Authorized Agent Signature Date (Revised 4/21/2022)