831 RUCKER AVE 2024-06-12 - Laserfiche WebLink

E BBLDING PERMIT APPLICAT PN 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 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION . PROJECT SITE ADDRESS: STREET 8"j1 g,u6_,,e- .,e_ QJ E-N t l'el PARCEL#: U(5 ,2..I L 015 DU CITY_E-1 2GTT- STATE 1,)R. ZIP 98 2 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): • LEGAL DESCRIPTION for new construction: Short Plat/subdivision: R, ri LAAp CD Lot No.: 16- 1l (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ra Nt I . 7--154()ti.,%12-1 OWNER MAILING ADDRESS: STREET g3\ ,y P 4,1.F,,lu CITY T.I f j t-•--- STATE to A ZIP 9 s2 jn OWNER PHONE: (2 c(D> 9 I —D to I S OWNER EMAIL: . CONTRACTOR COMPANY NAME: Wts-R4.1l,l- \,.. WA STATE CONTRACTOR LICENSE#(REQUIRED): W ES-1-H *26 1 e I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 12e)1 D N.F 1-1 e`- sT, 1 t i- i CA CITY tl`)DOn1W4 111-1= STATE IN A , ZIP 9 8d'12• CONTRACTOR PHONE: (425) LID 3- 0119 CONTRACTOR EMAIL: 6(Arf 1 S e tx5i-1ri,It,Ac. • C�✓1 PRIMARY CONTACT: ❑OWNER itCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Co 1,x _ A-b-e,1 CONTACT EMAIL: ,,, BUILDING INFORMATION VALUATION OF WORK:$ —1,D 4n 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: Si r4L,te l.t-k(,...-f PROPOSED USE OF BUILDING: 0,0 (,'t`1q.i..1L,r._ HEAT SOURCE: Gas ElElectric ❑Other BUILDING TYPE: ii SFR ❑Townhouse ❑Duplex ❑ADU OMulti-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ®Remodel ❑Repair ❑T.1. ❑Change of Use • ❑Modular ❑Portable ❑Re-roof ElExterior Alteration ElTank(above ground) ❑Accessory Structure ElFence over 7ft high ❑RackStorage ElPool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: W t I3.4D taw g-CecA-L..�r-(G4.t 7— • ACKNOWLE EMENT.•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 fed ral, tate,and ocal law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building ffici before be ng auth. ed un.; any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and 1 c ply ith the Sta a Cont.ctors Law :.27 RCW a . ':. 0OA WAC. City of Everett Official Use Only PERMIT# , f D4 - 1'I - 2Dy2- ?)zzo4-©2,Z Own r/Au ••z..Agent Signature Date (Revised 2/8/2021) /Z