11310 EVERGREEN WAY 2024-10-24 - Laserfiche WebLink

E B•LDING PERMIT APPLICATTN CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHENGTON 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 11310 Evev j I en Wa' PARCEL#: OO i -1 ( 00 Ll n 15° . CIT Y Ev er {1 STATE W/ ZIP t�]O 40Lii SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): A 1.14D SC- i Le,,, g I 0 1-- LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT�g INFORMATION OWNER NAME: ro S S IJ I a -a n SsoCA Q T S LC OWNER MAILING ADDRESS: STREET C/o AIAD VIL pp a O X ,i c ./ i;,1,5 5 • `-o n Si- CITY Me ') 1*15 STATE TA ZIP 3Q t o i OWNER PHONE: q OI 4615 (o051J OWNER EMAIL: CONTRACT:JRCO ii7rtNYNi:ME: gotja.I ICUiJ`, , ._.-_Gj "LL , -rka- Royal-y mpanres ac lel4' WA STATE CON T RAC FOf2 LICENSE#(REQUIRED): 60D Sa 0 5 J 0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 2\O61 ci e T p+0 in Si- my Y S lv1OCc V' STATE I N ZIP yea 7`4 CONTRACTOR PHONE: — CONTRACTOR EMAIL: '-2nS„ile roust f oa n co PRIMARY CONTACT: ❑OWNER E,CONTRACTOR ❑OTHER(Please Specify) c CONTACT NAME: IC:ONTACT PHONE: O la 5a3 S 30 2• Le Pr n n S wee-r)ey CONTACT EMAIL: ceosi nciG rotia PII — � BUILDING INFORMATION -I VALUATION OF WORK:$ 57�0� `�� 'ASSOCIATED LAND USE PROJECT#(if applicabl @SW/ S17 (Valuation shall include the prevailing fair m rket value of all labor,materials,and equ pment needed to complete the work.whether actually paid or not.) EXISTING USE OF BUILDING: A U+O P�airf. S cr(M� PROPOSED USE OF BUILDING: \O C ►(,lzVl�e- ro o-1 o h I Vi 31,314 L 1 2024 HEAT SOURCE: ❑GasAW ❑Electric ❑Other OF "ERES BUILDING TYPE: LJSFR LJTownhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercia�` i piSelfu�t (TYPE OF PROJECT(check all t at apply): ❑New Constructicn ❑Addition ERemodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable Re-roof ❑Exterior Alteration ❑-Bank(above ground) ❑Accessory Structure ❑Fence over 7ft high '=_iRackStorage ❑Pool/Hot Tub ETank(above ground) ❑Other: DESCRIPTION OF WORK: e Ill'1`;I Y r� 4 j� o m-e ! Ins-Vai( Duro-Blue, Serara-l-or sheer- q 50 wit;(, SI nji6 PA/ m v i s �y "of.' NU 5 jTU(kAvrtU c qrs • �SI.z. sq, -P+ . Enkire RA,-I- roaF re.eoveir 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 4CarlAIASIAite, If ktUr 6(6/91y PERMIT# .62 { V l lK J V it Owner/Authorized Agent Signature Date (Revised 4/21/2022)