1610 106TH PL SW A, B 2024-12-09

BUILDING PERMIT APPLICATIR 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 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1 10 106th pl se PARCEL #: CITY Everett STATE Wa zip 98204 SUITE/UNIT # l l'S FLOOR #: 60' Pratt ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction Short Plat/subdivision. Brookside Estate Nd of No 5 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:BrookSlde Estates NW LLC OWNER MAILING ADDRESS: STREET 10511 19th Ave S.E. Suite C CITY Everett STATE Wa zip 98208 OWNER PHONE:425-754-8686 OWNER EMAIL: Iarryklel @ mac.com CONTRACTOR COMPANY NAME:KLP, Inc. WA STATE CONTRACTOR LICENSE #(REQUIRED):KLPIN**044KP ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): #44666 CONTRACTOR ADDRESS: STREET10511 19th Ave S.E. Suite C CITY Everett STATE Wa zip 98208 CONTRACTOR PHONE:425-754-8686 CONTRACTOR EMAIL:Iarrykiel@mac.com PRIMARY CONTACT: m OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Larry Kiel CONTACT PHONE:425-754-8686 CONTACT EMAIL: larrykiel@mac.com BUILDING INFORMATION VALUATION OF WORK: $550 6.00 CO TASSOCIATED LAND USE PROJECT # (if applicable):PW2206-01 1 (Valuation shall include the prevaihUgAir market value of all labor, mate als, and equipment needed to complete the work. whether actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING:NeW duplex HEAT SOURCE: ❑Gas mElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhous mDuplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : mNew Construction ❑Addition ❑Remodel ❑Repair [IT. 1. []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 WORK: Build a 60' pratt duplex on lot 5 D JAN 0 7 2024 CITY OF EVERETT Permit ACKNOWLEDGEMENT 1 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 1 am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. 12/18/23 Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # (Revised 412112022)