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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425.257.8810 1(E)everetteps@everettwa.gov i(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1913 Oakes Ave PARCEL#: 00437938200601 <br /> CITY Everett STATE WA zip 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short PlaUsubdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Darlene Weber <br /> OWNER MAILING ADDRESS: STREET 1913 Oakes Ave <br /> CITY Everett STATE WA ZIp 98201 <br /> OWNER PHONE: 425-242-3162 OWNER EMAIL: dariene.knOWs.@hotmaii.com <br /> CONTRACTOR COMPANY NAME: Evergreen Seismic, LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): EVERGSL823JF ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 61248 <br /> CONTRACTOR ADDRESS: STREET 21304 82nd Pi SE <br /> cm. Snohomish STATE WA ZIP 98290 <br /> CONTRACTOR PHONE: 206-715-3957 1CONTRACTOR EMAIL: Info@evergreenseismic.com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 206-715-3957 <br /> Matt Robinson CONTACT EMAIL: info@evergreenseismic.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 5120 1ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: SFR <br /> PROPOSED USE OF BUILDING: SFR <br /> HEAT SOURCE: ❑✓Gas ❑✓Electric ❑Other <br /> BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ✓❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub [-]Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: 7-0 <br /> 74 FE <br /> SEP 1 ? 2024 <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work dons A rst }his a dr. m /y with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations Mu(�fir�t b�9uthoriZe in,kva�'i gg from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to pertoirri the td6rk7o'61f/)/A� 0pplIcation is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG <br /> *6dfi0-1-- <br /> 8/14/24 City of Eveeretttt Official UseOnly PERMIT# FT4(4' <br /> D ! �/ <br /> Owner/Authorized Agent Signature Date (Revised 21812021) <br />