5022 DELAWARE AVE 2024-08-02 - Laserfiche WebLink

BUIL ,NG PERMIT APPLICATION. D LECEOVE)EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements n numtrjf_oPc I�s rr88pd for rWASHINGTON then drop off completed application plus all required submittal documents to 320 ar Street 2n�FloornT'"ke Dro CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov (W)everettwa ov/ ermits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY C L�VCRC T l f crmtt �erviccs PROJECT SITE ADDRESS: STREET C O22 ,De 443 4 F PARCEL#: CITY E-1P I/P STATE IA P 4 ZIP $26 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: k (1(1.7 ltQi.J ( - dc, OWNER MAILING ADDRESS: STREET 5 0,2 cd ye A I/ Crry �LJ Ve T STATE k/4 ZIP OWNER PHONE: OWNER EMAIL: l t l C�� /Gp(�y�� ur��, p � C — CONTRACTOR COMPANY NAME: O 1i. Nei V (NA Cu (z v -Q 6 g)uLL i I. - WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: , kiti\ ctiC��J C--k- a CONTACT PHONE: 42- I CONTACT EMAIL: �u 12 wJNe 9\ a),I.BUILDING INFORMATION INFORMATION VALUATION OF WORK:$ .3 C cc-1—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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas electric ❑Other BUILDING TYPER ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ©Addition ❑Remodel ❑Repair EI. ❑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: 1 NA, 6/0 ci- L- rN C c C: 1,.Q y1n Ct 11 b c - - C `42_, A Ate` -L'_rc_ reyty w-- 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC City of Everett Official Use Only d PERMIT# Owner/Auth rized Agent Signature Date (Revised 4/21/2022)