3610 UPLAND AVE 2024-01-05 - Laserfiche WebLink

IR .... I [ ©E IV11.1 B DING PERMIT APPLICATIA EVERETT SUBMITTAL INSTRUCTIONS:See CITY OF EVERETT PERMIT SERVICES FF8 21 2023applicable submittal checklist for submittal requirements armber cm copies required for re" ' WASHINGTON then drop off completed application plus all required submittal documents to 3200 CeOgr, r t�rd F,lo.prAutottl,Box. CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)ev t g. e (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PCI is Ill Services PROJECT SITE ADDRESS: STREET Rol e I,j9jJ} i V 4tv� PARCEL#:160-e-IrZerr CITY STATE 4,0 AZIP �•///777 g'`7©''' SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): r TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot.No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ,,JoIfs, HA.0411gjsj OWNER MAILING ADDRESS: STREET %10 U f L.Ai'-1P A\) - ja rr- CITY I STATE IAI4 ziP4g2‘,3 OWNER PHONE: Ll 2 4"/ - b,O7 ( OWNER EMAIL: , J J 6 4 4eo & 60,416 -5T't -- CONTRACTOR COMPANY NAME: OWP-- - WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: RIOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: p./CS , 5. I Z- �i0'07 Uothl M C A. CONTACT EMAIL: J J L 114 A'p to @ (ti.9f0z_ T. lJ�"T > BUILDING INFORMATION VALUATION OF WORK:$ 100 a See 640N4)619ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market e of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: /;0 /L.aC y 7-0( eei^ PROPOSED USE OF BUILDING: p Pa HEAT SOURCE: DGas ❑Electric ❑Other U I4 bt.Q 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: 'o W-1}W 1 ,93UA' if DESCRIPTION OF WORK: 25a x 9 4 V 6(-1 ('A J ... co04 ,0,D,D I /' 3' fJt"- fa92P RN A I- Zr1414 «l q t P4 It o - o Cr 2. i i if-''re 2v 25 R,e- F: E A 3-0 2 - 14 t 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 WAC. City of Everett Official Use Only e —"�® » PERMIT# A 3 0R 0q7 r/Authorized Agent ign at� Date (Revised 2/8/2021)