3006 15TH ST 2024-12-09 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, W ASHINGTON then drop off completed applicalion plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425.257.88101 (E) everefteps@everettwa.gov 1 (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET / E7 PARCEL'#: LL3 (� / 6 t) CITY —vere- STATE Wrti ➢P 2d SUITE/UNIT #: FLOOR M ADDITIONAL LOCATION INFORMATION (f applicable): TENANTIBUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction. Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: S (,,, {- OWNER MAILING ADDRESS: sri Ee-r %2 v its - e 5 c: Lk e, rt :90 6 CITY eUr d Aloe STATE 6k)(9l ➢P 83 � ) OWNER PHONE: rj rj/ ( 11 (0 t OWNER EMAIL: GL!. j Gtr1U,l r O Lt/- CONTRACTOR COMPANY NAME: /U A A STATE CONTRACTOR LICENSE #(REQUIRED): A11A ICITY OF EVERETT BUSINESS LICENSE *(REQUIRED): CONTRACTOR ADDRESS: STREET Cm STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Do-ut A '�Ml+-kb Lk CONTACT PHONE: d ' 1161 CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK: S v ASSOCIATED LAND USE PROJECT # if a livable (Valuation shall include the prevairing fart marks value or all labor, materials, and equipment needed to complete the work. Whemeractuely paid or not.) EXISTING USE OF BUILDING: 105 1 d e 0 t PROPOSED USE OF BUILDING: Q 5 I 0-4 HEAT SOURCE: []Gas Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse pbuplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition pemodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re -roof ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure ❑Fence over 7tt high ❑RackStorage ❑PooVHot Tub ❑Tank (above ground) ❑Other: DESCRIPTION OF WORK: �' rn)no(- ChAttd s +Z) (oier floor. Dlzm ROOr P(�U C(faN�rPS {� hafdt�oowt� move si�il� �r le¢ ACKNOWLEDGEMENT1 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 arty authorizes approved work and no deviations therefr m 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 RC and 296.200A WAC. City of Everett Official Use Only PERMIT # (Revised 2/82021)