1203 SE EVERETT MALL WAY GROVE AND KANE 2024-05-02

BOLDING PERMIT APPLICATON CITY OF EVERETT PERMIT SERVICES ECEOVE EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements umb��r�QQ,f opies required for r i WASHINGTON then drop off completed application plus all required submittal documents to 320 ar SttW1nd)F�3or2@f4e Dro CONTACT INFORMATION: (P) 425.257.8810 1 (E) everetteps@everettwa.gov I (W everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION EVERETT PROJECT SITE ADDRESS: STREET 2 O3 — f`�1 SE rvcr a ARCEL #: t71!ll-ert3rVICt3$ CITY STATE - - ZIP SUITEWNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): yy 1,�I,rCvj 5p %A51'►je55 — p %v,4 LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 4/IWI A GGG OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: /� CONTRACTOR COMPANY NAME: - t S S LL C- t - 60 609 "7,50a pp WA STATE CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET 4-g1 w, G P vv1 Dr, CITY rdt STATE WA ZIP Zd's CONTRACTOR PHONE: ` 2 S—Z) 0 _0OCAS CONTRACTOR EMAIL: n 5k ir S cls Wt2 PRIMARY CONTACT: WNER 4SONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: C S,5TACT LONTACTPHONE:Jz-m1 EMAIL: ('Ov151.i S"I-kdi$ iVt2t`�.CC>>°"f BUILDING INFORMATION VALUATION OF WORel S p ®O ASSOCIATED LAND USE PROJECT # (if applicable): (Valuation shall include the prev ling fair market value o all labor, materials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF BU DING: `% c "A - PROPOSED USE OF B 'S C n C 1 HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ommercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition iZAemodel ❑Repair ❑T.I. 2TChange 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: Chav`5ihq-q 12��,�, �— -�ry 3 ro a-vi s L, 0 d'eb-cj +,> I-L r r vw,k 11ro V,% sA-� 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 1 am authorized by the owner of this property to perform the work for which application is made, and 1 71,11, ntractors Law 1 & 27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # thor' d gent Signature Date (Revised M12021)