4815 BAKER DR 2023-10-25 - Laserfiche WebLink

E BUIS:PING PERMIT APPLICAT14111 CiTY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASFIINGTON 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 4615 5414ER. QR(VE PARCEL#: 004174 QOooe, 2O0 CITY EVER- STATE VA ZIP 102,0 3 SUITE/UNIT#: FLOOR#: — ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): 01 itic ' LEGAL DESCRIPTION for new construction: Short Plat/subdivision:04i40f I1 4SAC(LEr Lot No.: I (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: LL'l!V a g4CKLEAI OWNER MAILING ADDRESS: STREET 4$1 S $Av£R- pill VE CITY F-V L. .Z.11— STATE W Ar a, q 8 20 5 . OWNER PHONE:.4'LS• 3 4$ • c4 5$ OWNER EMAIL: it �@ fjr' .ors\ �J CONTRACTOR COMPANY NAME: USA 7ull.OEs r R WA STATE CONTRACTOR LICENSE#(REQUIRED):UrAGegrof cc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C 3310 CONTRACTOR ADDRESS: STREET 1+oo It 2l"'`/ SE s-crt TS too CITY 'f3Etts.vu E STATE VIA... ZIP `IP0Olt CONTRACTOR PHONE: gt2,5"-* 665". 00 CONTRACTOR EMAIL:V52 9 rrhbfr ole rQ9 I id. on _ PRIMARY CONTACT: ❑OWNER El CONTRACTOR L tHER(Please Specify)AYC�•tiA4-40— CONTACT NAME: 3'p iJ/e4'(v, JJ BRA.k.sor CONTACT PHONE: 2 j6. 6,0 1 L . G 31 CONTACT EMAIL: CAkra JIPayetot. .iNg.-+ BUILDING INFORMATION VALUATION OF WORK:$ (45,O00 ASSOCIATED LAND USE PROJECT#(if applicable): N( (Valuation shatl include the prevaiing fair mbrket value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: S Fik PROPOSED USE OF BUILDING: Sr R. HEAT SOURCE: ,,.--,,❑Gr�as EErctric ❑Other BUILDING TYPE: L f-R ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction L`'(pddition ['Remodel ❑Repair ❑T.I. LiChange 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: provi.4 * (4.4r a 1 ♦ - e vt 4v ` 'ii-r ""^ re a . 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. PERMIT# City of Everett Official Use Only 4r72Z �u 5Z105 — °SW Owner orized Agent Signature Date (Revised 2/82021) !/ZN_