125 46TH ST SW 2024-06-25 - Laserfiche WebLink

L RIM BODING PERMIT APPLICAT NIKI E�'E R E T T CITY OF EVERETT PERMIT SERVICES 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 (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: sTREET/2s d t4 S 7 SW PARCEL#: y 95 0000 0.50 CITY.._ G'V(f STATEWA __.-ZIP.__..... (2._Kl.J�� SUITE/UNIT#: 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: --5A.f a D/5,i't t)✓ ct yet /S O OWNER MAILING ADDRESS: STREET /Z 5 9 S 1' sc.,/ Cnv EVefett STATE WM ZIP ccZo3 OWNER PHONE: (2,06) 2,00 - 5s 7 OWNER EMAIL: 0IS O r,�- S Q,tO @ co .ST• 0"1 CONTRACTOR COMPANY NAME: ((C4 i o rl dO C l„0 rl 54'rtA C't re)el �^ 4 WA STATE CONTRACTOR LICENSE#(REQUIRED):014 Al vC C S-Iy8JITY OF EVERETT BUSINESS LICENSE#(RE 4® CONTRACTOR ADDRESS: STREET 4/20 ' ZZ./ /�04.4 S-E (AiIliti4 /y� CITY 44 OLt Y 1 o:ke 'E"fCt C f STATE ZIP ! ?0/�/ 3 CONTRACTOR PHONE: (y 2 ti 9 3/-2.3 g L/' CONTRACTOR EMAIL: S7 eel P. Gex,o r►J C Chi P.b �t PRIMARY CONTACT: 31 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: 1 CONTACT PHONE: (yz5� 3/ Z3 -y See COS./ r CONTACT EMAIL: 5' eve. d:q,✓++p,4 G 5.rel G,✓ 1•Ga�'N BUILDING INFORMATION VALUATION OF WORK:$ % So 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: R Sid ef14.'� 0 !la ,^'► e PROPOSED USE OF BUILDING: RES'(cher-11+140 fcr e r HEAT SOURCE: (, [Gas ❑Electric ❑Other BUILDING TYPE:1SFR ❑Townhouse '❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) DAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: n I(1441 Pr C'v)'t OcC P 1, T err%o,/i /t 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 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT#jC)/�1 /9 B \ o Owner/Authorizegent Signature ! Date (Revised 4/21/2022)