2405 FULTON ST 2024-08-02 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and numb r 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 1(E)PermitServices@everettwa.gov I(W)evere a.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: sTREET PARCEL#: CITY r STATE zip CfL 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: r4( OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: �p ( (0 WNER EMAIL: CONTRACTOR COMPANY NAME: NNHJT _ (-L(- WA STATE CONTRACTOR LICENSE#(REQUIRED): q-e(j�pty OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET jq7 'W CITY ,v`oy' STATE ZIP CONTRACTOR PHONE:PHONE:e 6( v 3 Z ONTRACTOR EMAIL: 01M PRIMARY CONTACT: a-OWNER ❑CONTRACTOR OTHER(Please Specify) CONTACT NAME: QONTACT ONTACT PHONE: EMAIL: YV1 BUILDING INFORMATION VALUATION OF WORK:$ C) 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 EfElectric ❑Other BUILDING TYPE: JESFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): []New Construction ❑Addition EZRemodel ❑Repair ❑T.I. Change of Use ❑Modular ❑Portable ®Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure El Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to his 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 1 am authorized by the owner of this property to perform the ork for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Dfficial Use Only PERMIT# Owner Authorized Agent re Date (Revised 4/21/2022)