1606 LOMBARD AVE 2024-06-12 - Laserfiche WebLink

i • • INN BUILDING PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, wASHINQroN then drop off completed application plus all.required submittal documents to 3200 Cedar Street2nd 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: STREETfG�L6 LUG CJG!•C /. VQ PARCEL# CRY STATE ' zIP (7?o./ SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable):, TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction; Short Platisubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: (!mil- 04-62 >,g10 I, n4-5 L-LG OWNER MAILING ADDRESS: STREET aQ4_ {o j , vI E w cscv AR ``, �} /'�/ cm 'j II 'i<„/'01 f , STATE N/^ / ' ZIP /fL!/ OWNER PHONE: 41a_5- $77 -017c- OWNER EMAIL: /it b `7 q,.- ei&ii r. -1 CONTRACTOR COMPANY NAME: S C�- WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CRY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION ov VALUATION OF WORK:$ I-j °9 L ASSOCIATED LAND USE PROJECT#(if applicable): (Valuat,on shag 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: Restd... PROPOSED USE OF BUILDING: 54"^^C HEAT SOURCE: as DEiectric OOther BUILDINGTYPE:416R ❑Townhouse ODuplex DADU °Multi-Family-_#Units: OCommercial "DAccessory;Structure TYPE OF PROJECT(check all that apply): °NewConstruction °Addition iligemadel ❑Repair ❑T.1. ClChartge of Use OModular ❑Portable ORe-roof ❑Exterior Alteration OTank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage OPool/Hot Tub ❑Tank(above ground) DOther: DESCRIPTION OF WORK: t ,d� 3�44 [3.i fr.) Li✓-cl�ts & te " "A") 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 end no deviations therefrom:Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.l 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 Law18.27 RCWand 296,200A WAC. City of Everett Official Use Only Idit 3 ) - I OwnerlAuthorizod Agent Signature ate PERMIT#o '(Revised 4/21/2022)