11020 20TH DR SE 2025-01-13 - Laserfiche WebLink

BI410.DING 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 (E)PermitServices©everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1 1020 24 20th Dr SE PARCEL#: 01148001900700&01148001900500 CITY Everett STATE WA ZIP 98028 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 R��R\`�://n�`t OWNER NAME:Silverlake Condominium Association OWNER MAILING ADDRESS: STREET CITY STATE ZIP O 8 202h 2/ OWNER PHONE: �J OWNER EMAIL: CITY OF EVERETT CONTRACTOR COMPANY NAME:TBA Q 0, SU n V ri`I/j q Pei mit services WA STATE CONTRACTOR LICENSE#(REQUIRED):VMSDI I32-S$ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5"J I D CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR C✓]OTHER(Please Specify) Owners Authorized Agent CONTACT NAME: CONTACT PHONE:929-928 1728 Fali Surjadi CONTACT EMAIL:account@B2engineers.com BUILDING INFORMATION VALUATION OF WORK: $40,000 O U 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:Residential PROPOSED USE OF BUILDING:Residential HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel CIRepair ❑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:Foundation Repair DESCRIPTION OF WORK: Installation 2" pin piles to support settling building foundation 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Fali Surjadi 4/15/2 PERMIT# 2„iii) 6 - O1/ Owner/Authorized Agent Signature Date (Revised 4/21/2022) I I�