6722 HIGHLAND DR 2024-10-24 - Laserfiche WebLink

E BUPUING PERMIT APPLICAT ICIP EVERETT 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 I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET CO-4.2_2_ 4 k(3Lirinj.aarivR., PARCEL#: CITY Vt * STATE vo W Pr ZIP 9'82.0 3 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): pe u1i r't e U.D an J 11 n l LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) (� CONTACT INFORMATION OWNER NAME: PatiVtrte l)!�'7C.'tCl\\� OWNER MAILING ADDRESS: STREET (p 42.2_ kV%q cl 20 � CITY 1�i* �3 STATE ��1( z I p a203 OWNER PHONE: Z-o6 82. SSsdl OWNER EMAIL: Pan\tic 1C -cLn Q cyrrial l , Cuy•, CONTRACTOR COMPANY NAME: C�� n .- WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: r('OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK: $ 300 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shad include the prevailing far market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not) EXISTING USE OF BUILDING: IQj2.6%c Q,t±1& PROPOSED USE OF BUILDING: N.r►� HEAT SOURCE: Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ETownhouse Duplex LADU ❑Multi-Family-# Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): New Construction EAddition ❑Remodel ❑Repair I. Change of Use ❑Modular Portable ERe-roof ❑Exterior Alteration ETank (above ground) EAccessory Structure EFence over 7ft high ❑RackStorage EPool/Hot Tub ❑Tank (above ground) ❑Other: DESCRIPTION OF WORK: l V—ercltruk C 44v► 'aA W tx\ Dw n C Zcbv+tvl C �' Qettro rv) , � 005 ECEOVE MAR 25 202't J • ACKNOWLEDGEMENT.i have reviewed this application and confirm the information contained herein is true and correct. Work one 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 t ryb f-kEra�d[�,Ga, 4 ram,the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to err p th war IL'w i"cl•fads 11 ion is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. I' C(T�I le rV I Ge City ofEverett Official Use Only k3 .....- " ' 3 121{ � t�i PERMIT# ( l/�5 l C Owner/Authorized.Agent Signature Date (Revised 4/21/2022)