5408 S 3RD AVE 2023-10-18 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL 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 (� z� // PARCEL M CITYZE At STATE ZIP 0 �d SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Platisubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREETCly CITY _�Q STATE // ZIP OWNER PHONE: &Y,25) SV �— OWNER EMAIL: �!� e� S'G� <Q S L1/)'1G�I 'f'oym_ CONTRAC-TOR 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: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONT 'T NAME: CONTACT PHONE: �a -) 501-- ` CONTACT EMAIL: BUILDING INFORMATION VALUATION OF RK:$ ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include a prevailing fair MrkeTVaFMf all labor ateria s,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE O ILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: []Gas Electric ❑Other BUILDING TYPE:IVSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: me c Stru e TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel epair My (#CIE hsEffi;TT ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory StructurcPermit Services ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: l2b.C, f 7 n /7 U �Q,r�l�� rz //1 i1� /?(�� GZ�o G2. !%CJ�x l C /_)Z Alr o 1 11 rlr Q� Ct yc S /2p� �ii/ 9 >< ' � ACKNOWLEDGEMENT.I have reviewed this application and confirm Ilia 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 Oficial Use Only PDT2310 - 60 � Owner/Authorized gent Signature Date (Revised 4/21/2022)