4828 DELAWARE AVE 2024-11-01 - Laserfiche WebLink

pECEINETh B_.LDING PERMIT APPLICATV CITY OF EVERETT PERMIT SERVICES MAR 0 8 2023 EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requiremend number of copies required fo view, WASHINGTON then drop off completed application plus all required submittal documents to 320061ThiSta2 lle-Flrop Box. CONTACT INFORMATION:(P)425.257.8810 1(E)everetteps@everettwa.gov I(W)e ® Qpve [[ Otvsoc (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4 DMA\Afftle€-Ar8 PARCEL#: CITY areiZaIrSTATE wit- ziPc18 3 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: C) L�lj �I�)l� Ra--Vocptek OWNER MAILING ADDRESS: STREET 4 IZ.ENI Lv' ) r1t PL1 z wilt. /�m CITY aVaZEW STATE ' ZIP '�'1 SjW3 OWNER PHONE:4E5-3os— 13)7© OWNER EMAIL:doi IEj @ QO\ com 1 v CONTRACTOR COMPANY NAME: ._ cc I1IJP .0_0 swacr1O1\ WA STATE CONTRACTOR LICENSE'(kgp t 65,S4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): p� � CONTRACTOR ADDRESS: STREET('e i(c) CA5 CJ r p Pj.g CITY �Y�' t' STATE ft ZIP CO2_,06 CONTRACTOR PHONE: A 2,5-2.=j1-- 663i CONTRACTOR EMAIL:61f K t9 her;,60 r rucA7on c b ohn4'1 ( PRIMARY CONTACT: ❑OWNER ,CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4.t1j5 m' _tbe' ri 012kOt " SIDe( 2. CONTACT � -,EMAIL:a( p 'I.-i v u 6 LfiCi tea EMciJ I.c :r`r BUILDING INFORMATION ff VALUATION OF WORK:$ 3b►90d ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value o a labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: S r� R, I�I� 1345em `m r A,L,li PROPOSED USE OF BUILDING: t fw / HEAT SOURCE: KGas ❑Electric ❑Other BUILDING TYPE: NSFR ❑Townhouse EDuplex laIADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition .Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessary Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: ':6IIiOL L rut e 1//,00i.5 4[ iAI&s 4- /-/iUdt(Dg- �5 E7: /i7"if i�.lX r'l � �(�v I/2-� `'I'JUf�'l�t/(� 7'U!(. 4-4/D E JL�4/Z2W Al s,'/V 16. WIfw gat N��e 166"TI9�rlt00OTh 1- -LOo TT /4) Pia/"7 -y , may Lech I-5 fil-kolbY iiErn/7E7)pMe-C , r5Pam► TE Pvn6, 15 PaZini 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 v PERMIT# �* '-, 60„te.,e__CdtAA,,a- 3 ,3 •23 - s� Owner/Authorized Agent Signature Date (Revised 2/8/2021)