2410 EVERETT AVE 2024-02-20 - Laserfiche WebLink

BUtDING PERMIT APPLICATIA 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2410 Everett Ave PARCEL#: 00437863300500 cm, Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Everett Div 1, Blk 633 Lot No.: 5,6 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:JOrge and Regina Chacon OWNER MAILING ADDRESS: STREET 2410 Everett Ave city Everett STATE WA ZIP 98201 OWNER PHONE: OWNER EMAIL: Reginachacon@yahoo.com CONTRACTOR COMPANY NAME: n \.t L. ��( Nart.1 WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.377.8786 Ma rti.r _R e rs CONTACT EMAIL:mreimers@conceptarchitecture.com BUILDING INFORMATION VALUATION OF WO :$15,000.00 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the p vailing fair market va of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BU • Idence R-3 PROPOSED USE OF BUILDING:Residence R-3 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 ERepair ETA. ❑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:Repairs to existing residence to remove previous unpermitted work ClesLA ‘ \A RECEIVED , Zg.-5DePt MAR 2 7 2023 CITY nF+ EVERETT N ACKNOWLEDGEMENT'I have reviewed this application and confirm the information contained herein is true and correct. Work done tiS�iErpFlnit)Cu's9comply with current federal,state,and local law. The• =•ing of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building_affic al before being-uthor'ed unde 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 1 comply wi e Stet- 'on actors Law 1:.27 RCW and 296.200A WAC. City of Everett Official Use Only ,,.:v 3/21/20230,011rea Owned '••ent Signature Date (Revised 4/21/2022)