4030 RUCKER AVE 2025-11-04 - 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)425-257-8810 I(E)PermitServlces@everettwa.gov l(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4030 Rucker Ave. PARCEL#: cm Everett STATE WA zip 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):ARCO/AMPM LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Mena Flemon OWNER MAIUNG ADDRESS: STREET 14023 2nd Ave. W. cnY Everett STATE WA zip 98208 OWNER PHONE:(206) 851-2720 OWNER EMAIL: menaflemon@hotmail.com CONTRACTOR COMPANY NAME: A_'N P---------) WA STATE CONTRACTOR UCENSE#(REQUIRED): CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(206) 851-2720 Mena Flemon CONTACT EMAIL:menafiemon@hotmaii.com BUILDING INFORMATION VALUATION OF WORK: $ 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) EXISTING USE OF BUILDING:Retail Store/Gas Station PROPOSED USE OF BUILDING: Retail Store/Gas Station HEAT SOURCE: EIGas ❑Electric ❑Other BUILDING TYPE: ❑SFR OTownhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial (Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.1. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ElExterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other. DESCRIPTION OF WORK:Opening up of a drive way and extending the retail store back as far as possibly allowed. Cutf\hi2-4a5) 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 taw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must rust be authorized in writing from the Building Official before being authorized under any circumstance.lam 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 RCW and 296.200A WAC. City of Everett Official Use Only 4-1476 4?6922 P IT# 2.0:10 ( Owner/Authorized Agent Signature Date (Revised 4/2112022)