5019 COLBY AVE 2025-01-15 - Laserfiche WebLink

BU•ING PERMIT APPLICATIOI 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 l(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5019 Colby Ave PARCEL#: 00377500000800 CITY Everett STATE WA ZIP 98203 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: David Schuerman OWNER MAILING ADDRESS: STREET SAME AS SITE ADDRESS CITY STATE ZIP OWNER PHONE: 425-422-1 687 OWNER EMAIL: ddschuerm@yahoo.com CONTRACTOR COMPANY NAME:Self-Performed WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY Everett STATE WA ZIP 98204 CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-422-1 687 David Schuerman CONTACT EMAIL: ddschuerm@yahoo.com BUILDING INFORMATION VALUATION OF WORK: $12,062.64 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: Personal Residence PROPOSED USE OF BUILDING: HEAT SOURCE: ❑✓Gas ❑Electric ❑Other BUILDING TYPE: ESFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. EChange of Use EModular ❑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: Install new Jacuzzi J-315 hot tub on basement level concrete patio below second level deck. Cost of hot tub shown in Valuation included installation. Power is supplied from existing 120v. receptacle, so no added work for power. 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 1 6af59c4-9297-41 25- Digitally signed by 16a159c4-9297-4125- PERMIT# bbee-e3da3c70c091 5/30/2024 E 2IV( - 00 bbee-e3da3c70c091 Date:2024.05.12 02:20:34-07'00' Owner/Authorized Agent Signature Date (Revised 4/21/2022)