1117 W MUKILTEO BLVD 2024-02-15 - Laserfiche WebLink

• • E BUILDING PERMIT APPLICATION E Kw I I CITY OF EVERETT PERMIT SERVICES 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATIONr PROJECT SITE ADDRESS: STREET II1 t 17 Veit* M UK I LTEO GCVO PARCEL#: cn E/EEE/ / STATE LIR ZIPgg203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION/(if applicable): TENANT/BUSINESS NAME(if non-residential): VLIII4111111W JAKoB r p/I2UR/V LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) Q p` CONTACT INFORMATION . OWNER NAME: JA Koi3 PyiIr'RN OWNER MAILING ADDRESS: STREET 62 IQ 9+h Ave WE CnY $ f}rrL€ STATE 1.,/1t ZIP I gll,t OWNER PHONE: SW— 72_0 —3"/6 OWNER EMAIL: J 4k06 f/Ij1�Ih� AyyGr�•�I�yt I ✓ t/ CONTRACTOR COMPANY NAME: P0)17T Of �/V/ 101 1 nC '� NM—VW° WA STATE CONTRACTOR LICENSE#(REQUIR : S� p C OF EVERETT BUSINESS LICENSE#(REQUI CONTRACTOR ADDRESS: STREET Os 2 L -/{t CITY evert/4 t STATE w'J ZIP 9Qzo3 CONTRACTOR PHONE: 7 2S '772 ` g 207 CONTRACTOR EMAIL: ( poi)1.0 f Viik•R PRIMARY CONTACT: ❑OWNER )(CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK:$ S,000 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: I dcii i PROPOSED USE OF BUILDING: resiiniAl HEAT SOURCE: ;f6Gas ❑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 MRe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: RO‘Nodel r14111 -Poo .11pdS4` k w`- 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 JA)#/ s/2 zz P — 02� Owner/Authorized Agent Signature Date (Revised 4/21/2022) //