1026 HOYT AVE 2024-11-01 - Laserfiche WebLink

BL._DING PERMIT APPLICATI" CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASNINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.88101(E)everetteps@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET (> 040 N�j1 AJ' PARCEL#: 0Old (OS I;;)4l�o 3NC250 0 STATE WDr ZIP CIZ 20/ SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): 1 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: �•Jd'�i�;� i,.1 � , �`\ 7 OWNER MAILING ADDRESS: STREET v , \r\.2.--1 rr CITY u.e 4.e. ` STATE ct w c ZIP �0 OWNER PHONE: y �� r Gj.S3 OWNER EMAIL: ✓,L 'L iY 7 CONTRACTOR COMPANY NAME: i)W Mr(-- WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: CI'OWNER 0 CONTRACTOR 0 OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: ` ( l•4 �` CONTACT EMAIL: BUILDING INFORMATION ./s). VALUATION OF WORK:$ , 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: PROPOSED USE OF BUILDING: HEAT SOURCE: OGas ❑Electric ❑Other BUILDING TYPE: 12 t.FR ['Townhouse ODuplex OADU ❑Multi-Family-#Units: ['Commercial ❑Accessory Structure TYPE OF PROJECT(check al/that apply): ❑New Construction OAddition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ORe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ORackStorage OPool/Hot Tub OTank(above ground) ❑Other: Lfz,'1V_ E...)c f-'n'-I v i DESCRIPTION OF WORK: f� (r , bx n�\ �-� ', -) s C-9`��2,:y 12•- - -•el" -1v O m,�r\U d�. t CX'11 RECEN MAR�� cc28 2024 ACKNOWLEDGEMENT:f have reviewed this application and confirm the information contained herein is true and correct.Work pUrshasib,�diVpFwft71 bw9t I mpiy with current federal.state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Devialionst d ethf il�esttr 4t silting from the Building Official before being authorized under any circumstance.tam the owner.or I am authorized by the owner of this property to perform,t}Ie wor for w ich application is made. and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Owner/Authorized Agent Signature ' Date (Revised 2,182021)