515 72ND ST SE 2023-08-24 - Laserfiche WebLink

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 1 (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 515 72nd ST SE PARCEL#: 28050700202600 CITY Everett STATE WA z1P 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): Everett AFH LLC LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Everett AFH LLC OWNER MAILING ADDRESS: STREET 14615 NE North Woodinville Way, ste 108 ATTN Jordan Rock CITY Woodinville STATE WA ZIP 98072 OWNER PHONE: 425-446-2073 OWNER EMAIL: Jordan@alliancenursing.com CONTRACTOR COMPANY NAME: R2J2 Construction WA STATE CONTRACTOR LICENSE#(REQUIRED): R2J2CCL821 LJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60692 CONTRACTOR ADDRESS: STREET 6451 McLoughlin Drive CITY Central Point STATE OR zip 97502 CONTRACTOR PHONE:4255249927 CONTRACTOR EMAIL: jeff@r2j2construction.com PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR IdTHER(Please Specify) Project Lead CONTACT NAME: Jordan Rock CONTACT PHONE: 4254462073 CONTACT EMAIL: Jordan alIiancenursino.com BUILDING INFORMATION VALUATION OF WORK: $ 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: Single Family Residence PROPOSED USE OF BUILDING: Adult Family Home HEAT SOURCE: 022'as ❑Electric ❑Other BUILDING TYPE: FR ❑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) LZther: Adult Family Home Inspection DESCRIPTION OF WORK: Looking to have building inspection done specific to Adult Family Home prior to Licensing with the State of WA. 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 1 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 WAC. City of Everett Official Use Only PERMIT# Owner/Authorized Agent Signature Date (Revised 4/21/2022)