620 112TH ST SE SPACE 17 2024-08-07

in BUIING PERMIT APPLICATION, 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 l(E)PermitServices@everettwa.gov I ON)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SiTE ADDRESS: STREET 620 112th St SE,Space 17 PARCEL#: 009600-057-017-00 CITY Everett STATE WA zip 9B208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lago De Plata(MH Park) Lot No.: 17 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Georya and Dottie Johnson OWNER MAILING ADDRESS: STREET PO Box 12627 Mill Creek WA 98082 CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:Walker Construction WA STATE CONTRACTOR LICENSE#(REQUIRED):WALKEC*8940A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): L.�t t.�( - CONTRACTOR ADDRESS: STREET 1242 State Ave., Ste 1, PMB 265 CITY Marysville STATE WA ZIP 98270 CONTRACTOR PHONE:425.359.7650 CONTRACTOR EMAIL:walkerconstructionbuilder@gmail.com PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR L✓l OTHER(Please Specify) Permit Manager CONTACT NAME: CONTACT PHONE:425.238.6324 Stacy Smith, S L®S CONTACT EMAIL:stacy@stacysmith.net BUILDING INFORMATION VALUATION OF WORK:$ 290, 000 . 00 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:site previously occupied by manufactured home which was recently removed PROPOSED USE OF BUILDING:manufactured home-single family residence HEAT SOURCE: EGas ©Electric ❑lOther BUILDING TYPE: ❑✓SFR ❑Townhouse EDuplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ETA. ❑Change of Use FModular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage EPool/Hot Tub ❑Tank(above ground) C✓iOther:Manufactured Home DESCRIPTION OF WORK: Installation of new manufactured home on site previously occupied by manufactured home. Connection to existing utilities. Installation of neU l yya and 6 x 10 deck at front door and 4 x 4 deck at rear door. D IDS' jJ v1 nn ill NOV 15 2023 pi ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true and correct.Work dorm s(ianTfd thi ar4Ru grrTily with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations m e tru itiodil rg from the Bulb ial 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,rid 1 complA, the c`tis Law 18.27 RCW and 296.200A WAG, if i 1 .x City of Everett Official Use Only ti l PERMIT# /�l 'r' 10.31.2023 I ' v l e"ten rf thoriz nt Sig ature Date (Revised 4/21/2022)