617 LEGION DR 2024-02-14 - Laserfiche WebLink

BIDING PERMIT APPLICATON 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 uj 17 PARCEL#: 3 VCOG 3 0 Qvy>0050 CITY . ere t 1- STATE V if ' ZIP /c: SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): NANT,BUSINESS NAME (if non-residential): Nevi h1 ( \N Y) Z i LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: $.')Ck t,k Ct S uc.'t e V 1 c c-i OWNER MAILING ADDRESS: STREET J(,' I - 15` Tr3 I. S CnY r�t1I e vLlC STATE V ir ZIP C , C, OWNER PHONE: (L-C:45) 9 3 OWNER EMAIL: CO*A.\CA t^(_'Cj a 6. h ortrocA cc it CONTRACTOR COMPANY NAME: C,l l,` ‘' 1 C WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: sIREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: XOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: ip ` �� CONTACT PHONE: (y )5) ,�5 / ! 3 y LI 3 rco.kCONTACT EMAIL: f ekt.X �—_ (., ,y-0 g ©t mcc i) . CU t1') BUILDING-INFORMATION VALUATION OF ORK:$ ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include th p f it ma t va ue of all labor,materials,and equivalent needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: n P (� rn I I Ie3 t el e r T PROPOSED USE OF BUILDING: A d Gt 3/L' HEAT SOURCE: ❑Gas L Electric ❑Other BUILDING TYPE: iSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition Xiemodel ❑Repair ❑T.I. ❑Change of Use El 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: rg Ck o\ ocA kroc v e i 5i )1 Bot'1�� 5 J co om c rig, PP( e -t-ck1 s t n I< 1-6 I� , 5kowe,c) Con VerTi v]3 C( ear \ von 0- "-Ve_ 9arale . 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 Contracto Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 77 i� /�JP6Ta PER # .....1.?V 11 YJ[, Wi l / Je /Owner/Authorized Agent Signature D (Revised 2/8/2021)