804 91ST PL SE 2024-04-12 - Laserfiche WebLink

Bei4G PERMIT APPLICATOW 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 etQCP q( c'r' el • PARCEL#: CITY E l/r STATE j ZIP 4 0'02(0g SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): l TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: i( . ) etVu.— rJ co Q-1_ ^�Q` OWNER MAILING ADDRESS: STREET p-a. 9 • Vif t�/rrl CITY O STATE �J "l ZIP Cr QCj OWNER PHONE: a 0 ib `t '0 2 1- OWNER EMAIL: S eO ��lam Ceele_ q(117 0.24 , t� CONTRACTOR COMPANY NAME: A, t M r�4-1.-c, aC,U JmBL C A/STc v c r; pa • WA STATE CONTRACTOR LICENSE#(REQUIRED): A4, 61�CN'' EVERETT BUSINESS LICENSE#(REQUIRED): b 'Z q3 CONTRACTOR ADDRESS: STREET 1 (G Z 1 _ 3_ M fd A(yam 5 crr G-14 (e STATE w ZIP l 7(l CONTRACTOR PHONE: �� CONTRACTOR EMAIL:l,f�( G �4 3 7 e0 Lr.7170,:v . G D.U" PRIMARY CONTACT: ❑OWNER L�ICONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: • CONTACT PHONE: C?O 6 ) 73 -7 -I CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK:$ 640 0 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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas reElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family #Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition LJR//emodel IrJKepair ❑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: • 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 before being au`orized 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 Cont is ctors Law 18.27 RC W and 296.200A WAC. 'I, w City of Everett Official Use Only 3-0 �^ PERMIT# 1132111 - O 4 , Owner/Authorized Agent Signature Date (Revised 2/8/2021)