1728 100TH ST SW 2024-01-04 - Laserfiche WebLink

BI DING PERMIT APPLICAT" - N CITY OF EVERETT PERMIT SERVICES V E R E T T 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 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits Slue or Black Ink Only Please) PROJECT SITE INFORMATION ROJECT SITE ADDRESS: STREET Lj�$ I D D"" I S W PARCEL #: f 2,14 (} 0 (Q l7 I� (� 1 CITY _ EV e--r STATE W,' { zip UITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): pA„j L TUonAt S s% =NANT/BUSINESS NAME (if non-residential): ;GAL DESCRIPTION for new construction: Short Plat/subdivision: �A01,JCA-'� �� I y Lot No.: attach 17 P J ( copy of long legal description) CONTACT INFORMATION WNER NAME: i LUT UX E IS L WNER MAILING ADDRESS: STREET 0 , 60' CITY ` �� STATE W A zip1(92sp WNER PHONE: 4Z5 .- SG - 2 ( c2 OWNER EMAIL• ONTRACTOR COMPANY NAME: j 7 pI�S S jlV 'A STATE CONTRACTOR LICENSE #(REQUIRED): Uf� j" j CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �- Z ONTRACTOR ADDRESS: STREET 'f. C . 6C CITY LA 'j-e S + STATE " ZIP 2/ ONTRACTOR PHONE: L�= G�Y� " t �(; CONTRACTOR EMAIL: RIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) (,ICI I I_ e7NtjN1ELL— ONTACT NAME: X CONTACT PHONE: (-- C" LA 2. — S" , CONTACT EMAIL: f- t I E F K F l ,`/ F, L, Q BUILDING INFORMATION ALUATION OF WORK: $ ZtP ' 0 0 1ASSOCIATED LAND USE PROJECT # (if applicable): aluation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) LISTING USE OF BUILDING: wJA �ZOPOSED USE OF BUILDING: 12fSin �)C .--:AT SOURCE: ❑Gas Electric ❑Other JILDING TYPE: WSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure 'PE OF PROJECT (check all that apply) : XNew 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: SCRIPTION OF WORK: , pleoepScp SF6� KNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with -rent 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 ilding 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, .1I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # ,nerlAuthio riz6d Agent Signature Date (Revised 412112022)