3516 ROCKEFELLER AVE 2024-06-24 - Laserfiche WebLink

• ECEVEBUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements numbfyicOcoTiffs red for r i WASHINGTON then drop off completed application plus all required submittal documents to 320 ar Stf� n29 Filo44-45ke Dro x. 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 CITY OF EVERt I I _ Per mit Services PROJECT SITE ADDRESS: STREET 3s) ( � CLL�-Q� A'c- PARCEL#: `T- /� vl CITY t‘i Etz�(' STATE wA— ZIP 9Q).21 SUITE/UNIT#: f } �I 6 . FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): 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: 3S Le&L t- , OWNER MAILING ADDRESS: STREET P , 0 P:57)? \ p Lf CITY V V O 0 1 •1 R't I( 1 1 STATE MIA— ZIP OWNER PHONE: al}4 •CCO OWNER EMAIL: 1 Sept\,a S GSM JU� - � •c•,AA • CONTRACTOR COMPANY NAME: N. WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: cqJWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:`^ \ CONTACT PHONE: ( ��4, coo SW\ \L k '`n(\>t'C11 CONTACT EMAIL: I S`r`(\0.11 - c, 1/10 $ Q C-LS• C..7514A BUILDING INFORMATION VALUATION OF WORK:$ L 0 DQ• ) ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair mar et value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: >u Lax • PROPOSED USE OF BUILDING: • Q-CA-v.....o-DG.2X HEAT SOURCE: ❑Gas (NItlectric ❑Other BUILDING TYPE: ❑SFR 0Townhouse3uplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition a1Remodel ❑Repair ❑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: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 circ s once.1 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 R 296. A WAC. City of Everett Official Use Only CtQ>*°)/ PERMIT# >it') ; brZ(' 0( IT,9‘ Owner/Authorized A t Si ure Date (Revised 4/21/2 2)