1217 LOMBARD AVE B 2023-09-26 - Laserfiche WebLink

om BUILDING PERMIT APPLICATION EVERETT 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) 425.267.8810 1(E) everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue orElackInk Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET PARCEL #: - STATE ZIP-7 SUITE/UNIT #: FLOOR M ADDITIONAL LOCATION INFORMATION (if annlicahial- TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Piat/subdivislon: _ Lot No,: OWNER NAME: "J - OWNER MAILING ADDRESS: STREET CM ER PHONE: CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE #(F CONTRACTOR ADDRESS: STREET CITY CONTACT INFORMATION -ye�rl e, /9tl{' STATE (attach copy of long legal description) OWNER EMAIL: CITY OF EVERETT BUSINESS LICENSE ZfP STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ....._.� .-...,._ ,....... .�....,,��. DOWNER ❑CONTRACTOR ❑OTHER (Please Specify) CONTACT N E: I6ti CONTACT PHONE: CONTACT EMAIL:.: z' BUILDING INFORMATION JALUATION OF WORK: li ASSOCIATED LAND USE PROJECT # (if applicable): Valuation shalt include theprevallingfairma et unnfallIAh,� mo a. ,...a,._..�____._.. EXISTING USE OF BUILDING: PROPOSED USE OF 13UILDING: HPATSOURCE: ❑Gas ❑Electric ❑Other 3UILDING TYPE: OSFR ❑Townhouse ❑Duplex C]AIDU ❑Muff! -Family - # Units: ❑Commerclal ❑Accessory Structure rYPE OF PROJECT (check all that apply). ❑New Construction ElAddition ❑Remodel ❑Repair OT,I. ❑Change of Use ❑Modular OPortable ❑Re -roof ❑Exterior Alteration C]Tank (above ground) DAccessory Structure [-Jfence over 7ft high ❑RackStorage E]Poo1/Hot Tub ❑Tank (above ground) ❑Other: )ESCRiPTION OF WORK: 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 currant federal, state, and local law, The granting of permit only authorizes approved work and no devlaBOnS therefrom. Devlatlons must first be authorized In writing from the Building Offlcial before being authorized under any circumstance. I am the owner, or l 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 298.200A WAC, City of Everett OfBofal use Only 67 -7 PERMIT# 7wner/Authorized At Signature Date (Revised 2/8/2021)