2817 MEDORA WAY 2023-12-08 - Laserfiche WebLink

• i BUILDING PERMIT APPLICA ON 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 Qnly Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2817 Medora Way PARCEL#: 00520300002200 cry Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): 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:SHU CHUAN CHANG OWNER MAILING ADDRESS: STREET 6530 NE 198TH ST cry KENMORE STATE WA zip 98028 OWNER PHONE:6262269678 OWNER EMAIL: Shuchuan1 1 12 p@gmaiI.COm CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:6262269678 SHUCHUAN CHANG CONTACT EMAIL:shuchuan1112©gmall.com BUILDING INFORMATION VALUATION OF WORK:$10000 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:RESIDENCIAL PROPOSED USE OF BUILDING:RESIDENCIAL HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ['Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ElCommercial ❑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:WE REMOVE THE CHIMNEY AND LIVE OPEN BUT THE STRUTURAL WAS GOOD NOW WE HAVE BLUE PRINT AND ON THE STAIRS WE HAVE TO AJUST THE HIGH I DID REMODEL THE REST LIKE THE BATHROOM AND THE KITCHEN BUT NO MODIFICCION JUST UPGRADE. 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 � "'^" ' 10/20/2021 ,, '� Owne O /Authorized Agent Signature Date (Revised 2/8/2021) / Il�