1223 RUCKER AVE 2024-12-02 - Laserfiche WebLink

BUILDING PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 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)425.257.88101(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATIO PROJECT SITE ADDRESS: STREET i VL ARCEL#: CITY STATE ZIP SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): LLEGAL BUSINESS NAME(if non-residential): ESCRIPTION for new construction: Short Plat/subdivision: ' Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CITY 1� STATE ZIP kvv OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: C) WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET clTv STATE ZIP CONTRACTOR PHONE; CONTRACTOR EMAIL: PRIMARY CONTACT - �_...._�_... WNER ❑CONTRACTOR El OTHER(Please Specify) CONTACT NAME: =CONTACT NE: C� V� 2c c �u V� L:. . BUILDING INFORMATION VALUATION OF WORK:$ , 00 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall Include the prevailing falr market val a of all labor,matenais,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas DElectric DOther BUILDING TYPE: ❑SFR DTownhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction DAddition DRemodel ❑Repair DT.I. ❑Change of Use DModular DPortable DRe-roof ❑Exterior Alteration DTank(above ground) []Accessory Structure DFence over 7ft high DRackStorage DPool/Hot Tub DTank(above ground) DOther: DESCRIPTION OF WORK: C(ecA4:" l4 (I /v e LA-1 1:�s._lu tl�'aA A c L10 _ D( U\jc&C( �kj ^b — f/ ACKNOWLEDGEMENT-I have revlewed 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 prope the work for which applkaro Is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. rty to perform City of Everett Official Use Only PERMIT# � t )caner/Authorized Agen SI nature Date (Revised 21112027)