2231 LOMBARD AVE 2025-01-10 - Laserfiche WebLink

"Orr s,jap4eu--- NMI BRLDING PERMIT APPLICATIR 194031eitiix4 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 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION 2n , PROJECT SITE ADDRESS: STREET 2z3 i r Low j ijt PARCEL#: 00451 I L( Q, u p CITY G M�.Q �) STATE N ZIP 9)'1 SUITE/UNIT#: FLOOR`#': "'VVV ADDITIONAL LOCATION INFORMATION (if applicable): 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: 54-o-el M OWNER MAILING ADDRESS: STREET 9 b2,0 kg, 20--0`3"r " CITY ' J STATE WA ZIP 1%O Li OWNER PHONE: '-Sc b_0 loll OWNER EMAIL: tek iA 1e1!11‘ /ln9110 L 1 t.l`vv CONTRACTOR COMPANY NAME: , G � u11,�rZv WA STATE CONTRACTOR LICENSE#(REQUIRED): 41roLu' 41 1%5)CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): . yye, CONTRACTOR ADDRESS: STREET G,�j41 2 R-�'�.�r' —' 30q) CITY ^� STATE A5 ZIP Ci.y C t CONTRACTOR PHONE: 1O10 SSA)•O(c 11 CONTRACTOR EMAIL: -reANN kr I. aatm e, 9rvvv U, PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 240 p ) 06 4/L=l{ Mgeve. �A"L"Q> il'�CONTACT EMAIL: dungy hiK t.i4ilvs, ti ea BUILDING INFORMATION VALUATION OF WORK:$ ( O'O O 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. �Dd EXISTING USE OF BUILDING: c PROPOSED USE OF BUILDING: SP(2- D 4 9 2024 HEAT SOURCE: ❑Gas lilElectric ❑Other MAY `� RE rr BUILDING TYPE: �SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Co erdAl r9*g�Ytt e TYPE OF PROJECT(check all that apply): El New Construction ❑Addition El Remodel ❑Repair CIT.!. Rename o`r UUse ❑Modular ❑Portable ORe-roof 0 Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: go Pit44s- ) vveAA, Oo-c c P ^e) t e w C.pt,l"->. 'V\t-W 'cI011 '16— Yam) GAS tNA , vA do ki';v %-V S , iv t,) plc ..Qa.o , V Lt v pet-th. * t. h,Qit,1 of w O s c . 0,401 e ,t,,,l ACKNOWLEDGEMENT*I 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# b/d „U „n I Owner/Auth t zed Agent Signature Date (Revised 4/21/2022)