1117 TTEREVE DR 2024-01-05 - Laserfiche WebLink

isiFOLF7 B DING PERMIT APPLIC cU CITY OF EVERETT PERMIT SERVICES EVERETT ff�, SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submitta - irem �ne rimn23f copie wired for review, WASHINGTON then drop off completed application plus all required submittal doc - is to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermltServlces@eveFgthya,poy-�rft:e rEppermits (Blue orBlackank-OnlyPlease) .PROJECT SITE INFORMATION Permit Services PROJECT SITE ADDRESS: STREET ///7 j7 • PARCEL#: 003/2$0/04Q//j,0 CITY t L/E i 77 STATE w,4. ZIP gg249 SUITE/UNIT# t� ,'1.. 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: DOA) $ 7i1G,z- f4j/ad/. OWNER MAILING ADDRESS: STREET JZ?j// 38 7PR S y^. CITY // STATE •1 V ZIP {"Yj 2.0i?' OWNER PHONE: 425-- 3S7-/2-/Q OWNER EMAIL: r/ao%/ne/504r/ &O , CONTRACTOR COMPANY NAME: CQ �j257 /4— 76p1',I/ Nc- WA STATE CONTRACTOR LICENSE#(REQUIRED):CDRA/ ip//( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3,3 t o CONTRACTOR ADDRESS: STREET $gig s .goat- Si sE CITY Sn hoynfS'h STATE .i/,t ZIP / g?---9� CONTRACTOR PHONE:1125-V 0/// CONTRACTOR EMAIL kris �64e/vF 7 M6� CO PRIMARY CONTACT: ❑OWNER I CONTRACTOR El OTHER(Please Specify) � � � CONTACT NAME: GD CONTACT PHONE: d oiD_-7�� _s ` li /9 /27/ber CONTACT EMAIL: k(kiS•T{ria(� j j Tek f./1��9T,v-► BUILDING`INFORMATION' I`' VALUATION OF WORK: $ O •D- / E 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: C~ ilj PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): CI New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ge-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ERackStorage ❑Pool/Hot Tub ❑Tank(above ground) ther: c/f. DESCRIPTION OF WORK: �J R°,vr�tb�vl! �ls-f7� 6UmPa��ern . leer yvis� /1.e4(1 Otfrnp9 ACKNOWLEDGEMENT:l 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# Aso 6 J Col 7 Own r uthorized Ag Signature Date (Revised 4/21/2022)