2113 106TH ST SW 2025-01-14 - Laserfiche WebLink

r z BUSING PERMIT APPLICATI ©t1llV CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirem and n r f i�{{op' quired eview, WASHINGTON then drop off completed application plus all required submittal documents to 2 Ce.i te1t2hd Intak p Box. CONTACT INFORMATION: (P)425.257.88101(E)everetteps@everettwa.go ( )everettwa.gov/permits (Blue orBiacklnk Only Please) PROJECT SITE INFORMATION el i Y U1- EVERETT PROJECT SITE ADDRESS: STREET Z' 0 / +A rj( ,,,2., PARCEL#: e9 ` 55W ` /7 j CITY aVere 1 ( STATE 1,4,_14 ZIP 1 4 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: ,-- __\,0� itov-z(e5 OWNER MAILING ADDRESS: STREET Zf 13--jC64h 51., SC".9 CrfY F-V e_i F'++ STATE 1, ZIP e)p,zC> OWNER PHONE: OWNER EMAIL: JO5 0V��(eS 16 €cct vi •C.C,1y CONTRACTOR COMPANY NAME: E� (. WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: OWNER ElCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: / CONTACT PHONE: —1 - etOVNZ.-6 CONTACT EMAIL: j5 BUILDING INFORMATION e VALUATION OF WORK:$ -"f• k O ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailingTair m et value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: e ( Le_ PROPOSED USE OF BUILD! • ��`elm I .Q4 c HEAT SOURCE: ❑Gas lectricllll ❑Other BUILDING TYPE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ['Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition gRemodel ❑Repair ❑T.I. ❑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 WO (� 1 , `S ytl" ?\�ltwl,� (A`i €.es.- d:t-� 1�11.2 ,c VIDJ� 4 c.( / Lisa'• �>>C i s`F 1 K bey, Q�.c.e�; .C-v; (e"�• �. l ic-t 4 i I trs'`rc 4-1 Y 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 C PERMIT# --- Owne nt Si ture Dat (Revised 2/8/2021)