10110 19TH AVE SE G 204, G 304 2023-12-11

• • p LE©COVG BUILDING PERMIT APPLICATION A CITY OF EVERETT PERMIT SERVICES APR 0 8 2023 EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for rev WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cec ry*a fplevlREr ox. � I� CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov I(VV)ev v/ ''�s--.,`` VICOf� (Blue or Blaclulnk Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 10110 19th Avenue southwest— 5 PARCEL#: 28051900100200 CITY Everett STATE WA zip 98208 SUITE/UNIT#: G204 G304 FLOOR#: 2-3 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Mercy Housing LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Family Tree&Lincoln LLLP OWNER MAILING ADDRESS: STREET 2505 Third AVE Ste 204 CITY Seattle STATE WA ZIP 98112 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: Interstate Restoration lV ig ci0 t WA STATE CONTRACTOR LICENSE#(REQUIRED):' e4ee CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 55636 CONTRACTOR ADDRESS: sTREET22342 68th Ave s CITY Kent STATE WA ZIP 98023 CONTRACTOR PHONE:3:°,349-6579 CONTRACTOR EMAIL:Mike.Bergman@firstonsite.com PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-349-6579 Mike Bergman CONTACT EMAIL:mike.bergman@firstonsite.com BUILDING INFORMATION VALUATION OF WORK:$3000.00 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:multi-Family PROPOSED USE OF BUILDING:Multi-Family HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ✓❑Repair ❑T.l. ❑Change of Use ❑Modular ❑Portable ❑Re-roof El Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other. DESCRIPTION OF WORK: Replace Insulation and Drywall in the 2 listed units Due to water loss. No alterations 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 3/29/2023 PERMIT# (b .D(4- 0 3 o Owne OfFiorized Agent Si• Date (Revised 4/21/2022)