5409 S 2ND AVE 2023-12-27 - Laserfiche WebLink

BUILDING PERMIT APPLICATION 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 5409 S. 2nd Ave PARCEL M 00500302700801 clrr Everett STATE WA zip 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short PlaUsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Michael DePhillips OWNER MAILING ADDRESS: sTREET 5409 S. 2nd Ave clTv Everett STATE WA zlp 98203 OWNER PHONE:412-702-8453 IOWNER EMAIL: dephillipsmichael@hotmail.com CONTRACTOR COMPANY NAME:Evergreen Seismic, LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):EVERGSL823JF ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 61248 CONTRACTOR ADDRESS: STIEET21304 82nd PI SE cl, Snohomish STATE WA zlp 98290 CONTRACTOR PHONE:206-715-3957 CONTRACTOR EMAIL:info@evergreenseismic.com PRIMARY CONTACT: ❑OWNER Z CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:Matt Robinson CONTACT PHONE:206715-3957 CONTACT EMAIL:info@evergreenseismic.com BUILDING INFORMATION VALUATION OF WORK: $8000 1ASSOCIATED 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 pald or not.) EXISTING USE OF BUILDING:SFR PROPOSED USE OF BUILDING:S FR 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.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:Voluntary seismic retrofit upgrade to crawlspace of SFR, per engineered plan set. No earth disturbance. ACKNOWLEDGEMENT:1 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 efore bei author± under any circumstance.!am the owner,or i am authorized by the owner of this property to perform the work for which application is made, and 7PERMIT ly w the Sta Contr fo Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only # 3 Z2d I — 0Co � u hor a Ag nt Ig Lure Date (Revised 218/2021)