1117 TTEREVE DR 2024-01-05 - Laserfiche WebLink

- (argEEr'' BIDING PERMIT APPLIC rli° CITY OF EVERETT PERMIT SERVICES ryrynn EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submitta• - irem ' ne r3mba23i copie uired for review, WASHINGTON then drop off completed application plus all required submittal doc • - -ts to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@evesgt`wta,_gor((:_W-- fety -g ermits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION tl� P11 prrit Services PROJECT SITE ADDRESS: STREET /1/7 Tit-er-e_Ve. Df• PARCEL#: 003gAvo-loU� CITY g/E 7 STATE w.4- ZIP qg2.j0/3 SUITE/UNIT#: P 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: DON $ � CJ '/d//. OWNER MAILING ADDRESS: STREET /Z3// 3.01 pie Se y^ CITY 61/ErLL- T V STATE r ZIP {g�a? OWNER PHONE: /A5-- 38'7- 210 OWNER EMAIL: r/df//f sa)ry &9 m//ai CONTRACTOR COMPANY NAME: CQ 10,j7 y/E 2Qd�/NI WA STATE CONTRACTOR LICENSE#(REQUIRED):COO/E&j/l//( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 335(p0 Y CONTRACTOR ADDRESS: STREET 5go5 $Zo - S7 SE CITY SrlD{?ol IS4 STATE Wit ZIP Q2'�--/4 CONTRACTOR PHONE:4'25-171gS- 7/// CONTRACTOR EMAIL:kr/S-7—y gejA/Ec2 % N6 PRIMARY CONTACT: ❑ OWNER yCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:C� G D CONTACT PHONE: 'f�``dL/J CONTACT EMAIL: k. S a sTaX-W •d®rt--1 BUILDING INFORMATION VALUATION OF WORK: $ $ ! i1 i 9 s cL." 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: 7—P/ex AALtLf1 /Nit / PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU [Dif tulti-Family-#Units: y ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable be-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: Remove ex,i s- T 6lrm ps7ern - We-Poe/ yt' — 4 i'v c nnPa' 2 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# Own r uthorized Ag Signature Date (Revised 4/21/2022)