2317 BROADWAY 2023-12-06 - Laserfiche WebLink

am 1311.DING PERMIT APPLICATA 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)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET j 1 $ROADWAY PARCEL#: C(7413 0-n0 07e'e' CITY .R 1I STATE WM ZIP qs 20 1 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): OL ,t'lucklAcHO AW LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: MATT PiZO c K 1-1.- OWNER MAILING ADDRESS: STREET (3.30 0\7 AVE 5543. cny Agy4 I LLe STATE WA ZIP 90 z70 OWNER PHONE: 36e, q -- Gc/2/ " OWNER EMAIL: CONTRACTOR COMPANY NAME: 1-7' Tf A7)VAN C E1) c-DNs71?U�oAl WA STATE CONTRACTOR LICENSE#(REQUIRED):CC 4fATTACer(FLCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60 1 0, CONTRACTOR ADDRESS: STREET OW 9. (?tA AVg E . /� , ` - CRY gD/_I oA/J s STATE IA/A ZIP 9e020 CONTRACTOR PHONE: 42 77/--// 9'2— CONTRACTOR EMAIL ANDY7 0 AA/Pr—EH CeVel PRIMARY CONTACT: ❑OWNER ' CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: ��/D I�/ CONTACT PHONE: 206 gT/— 12 2-2-_ A u` TE-I CONTACT EMAIL: mpyrvi (4ANp 7-- . COA4 BUILDING INFORMATION / VALUATION OF WORK:$ eO i,O o Q 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: A-Z RE-IA-Au r©V , --•O c 1T PROPOSED USE OF BUILDING: 1k 2_ 1' ., HEAT SOURCE: Was DElectric DOther BUILDING TYPE: DSFR ❑Townhouse ❑Duplex DADU ❑Mufti-Family-#Units: KCornmercial DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel DRepair Xt1'.I. DChange of Use ❑Modular DPortable ❑Re-roof DExterior Alteration ❑Tank(above ground) DAccessory Structure ❑Fence over 7ft high DRackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true end 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 �j g/t/t 7.4_ I7i`Ze.--2� PERMIT# l Qwnerll*u..�thoriz d Agent Signature Date (Revised 2/8/2021)