4004 RUCKER AVE 2024-06-24 - Laserfiche WebLink

ilimi rx B•DING PERMIT APPLICAlN 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET:-.100/ ILA—C. Aki PARCEL#: ct S 4 Z2Do cy'UU CITY Ev�ct'14- STATE WA ZIP gl2_C! j SUITE/UNIT#: FLOOR#: 7) C•- 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: c.-C\ 4, l�K%f>ryte, t�, `, L41 1�� (-4•- sc�iei[ c OWNER MAILING ADDRESS: STREET 9—CO 3Lj ,,A-Je )`)W CITY Sec -S\e, /,STATE L�P 11 ZIP 91 i 17- OWNER PHONE: 2 du- i -3-el f;(4-yHL?'g2ciZ OWNER EMAIL: \A1kc gwltyt,w P,41 l+t I'336 @n/1 (; l . AGM CONTRACTOR COMPANY NAME: 4)cl`c) ZI^.oc eat d G-tA,4\{',C 3 A - WA STATE CONTRACTOR LICENSE#(REQUIRED):/cX(I S 21 G- Llc CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):T!Vi el CONTRACTOR ADDRESS: STREET lcy31 . C A'' tL CITY T\tAcskit STATE 11j,A ZIP 9 d 2z 3 CONTRACTOR PHONE: j(.;(12- ()y 3 ^}-6(v") CONTRACTOR EMAIL: Ilc.;jr'e.. c Axi5(' c-u,,, <Aal }-e.C_Cu771 PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: `t 360_G'3 ._ 1-6(f 3 \ c& ee cNt 7l +l l+ CONTACT EMAIL: "Il{'-e-eA_,I S f cr,— &✓iC1' ,u4---7c-r c_,,, BUILDING INFORMATION VALUATION OF WORK: $ 22t `-{(ii I . CU 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:(-1,4t,e_tn,k PROPOSED USE OF BUILDING: a-.fArwe,(k-\— HEAT SOURCE: El Gas LElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 4Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ETA. ❑Change of Use ❑Modular ❑Portable YRe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: `9-e.yvt e*kS V� C. � SktKY-Q 5 ex A c� ce_ c e_ w i )-L� vet Cc t- Sk irli eS OCT0 CEIVEI 0 5 2023 CITY OF EVERETT ACKNOWLEDGEMENT:I have reviewed this application and confirm the information containe Q i Ittu6iel r44e.fA4/c'k 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only q,9,` 23 PERMIT Z�s�I�' vX DOn 41:44_ Owrier/Authorized Agent Signature Date (Revised 4/21/2022)