1011 GRAND AVE 2023-12-29 - Laserfiche WebLink

EIPLDING PERMIT APPLICAO)N 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 1011 Grand Avenue PARCEL #: 00385421401100 CITY 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: Clay and Helen Wertheimer OWNER MAILING ADDRESS: STREET 1011 Grand Avenue CITY Everett STATE WA Zip 98201 OWNER PHONE:425-238-7203 OWNER EMAIL: hapwert@gmail.com CONTRACTOR COMPANY NAME: Westrock Construction WA STATE CONTRACTOR LICENSE #(REQUIRED): WESTRCL8140K CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 61883 CONTRACTOR ADDRESS: STREET 5418 123rd Avenue NE CITY Lake Stevens STATE WA zlp 98258 CONTRACTOR PHONE: 206-850-8542 CONTRACTOR EMAIL: Jon@WestRockCon.com PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ✓❑ OTHER (Please Specify) Architect CONTACT NAME: Tom Rochon, Designs Northwest Architects CONTACT PHONE: 360-629-3441 CONTACT EMAIL: Tom@designsnw.com BUILDING INFORMATION VALUATION OF WORK: $120,000 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: Single Family Residential PROPOSED USE OF BUILDING: Single Family Residential HEAT SOURCE: ❑Gas ❑Electric Z Other Ductless Mini -split heat pump BUILDING TYPE: ❑✓ SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ZAddition ❑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: Addition of 482 SF to existing an Single Family Residence. 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 PERMIT # (Revised 21812021) z