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• <br /> BUILDING PERMIT APPLICATION <br /> EVECITY OF EVERETT PERMIT SERVICES <br /> RT T SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASH'NGTON then drop oft completed application plus all required submittal documents to 3200 Ceder Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425-257-8810 l(E)PermitServices( everettwa.gov l(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION; <br /> PROJECT SITE ADDRESS: smssr 4417 Colby Ave PARCEL;r 00407801103300 <br /> crry Everett STATS WA ap 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION Of applicable): <br /> TENANT/BUSINESS NAME(if non-residential); {I <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: 8/53 Lot No.:31 (attach copy of long legal ds sctlptlan) <br /> CONTACT INFORMATION <br /> OWNER NAME:IV(iles Pokorny <br /> OWNER MAILING ADDRESS: STREET 4417 Colby Ave <br /> our Everett STATE WA zip 98203 <br /> OWNER PHONE:20&786-1902 OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: Deck Pro <br /> WA STATE CONTRACTOR LICENSE*REQUIRED):DECKP##924BP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 7104( <br /> CONTRACTOR ADDRESS: sms:ET13110 NE 177th Pi, #227 <br /> csTy Woodinville STATE WA zip 98072 <br /> CONTRACTOR PHONE:206-786-1902 CONTRACTOR EMAIL:deOkpro.deCkS( Corncestnet <br /> PRIMARY CONTACT: D OWNER ('!Y CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206 7gg-1902 <br /> David Kievan CONTACT EMAlt.:d kpro,decks©comcast.net <br /> BUILDING,INFORMATION <br /> VALUATION OF WORK:$17,000 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> {Valuation snai Include theprevaNrui fair madtst value of al tabor,materials,and equipment needed to complete the work,whether actuagy paid or not.) <br /> EXISTING USE OF BUILDING:Existing Deck\Entertainment <br /> PROPOSED USE OF BUILDING:Replace Existing Deck, like for like\ Entertainment <br /> HEAT SOURCE: [ Gas °Electric °Other, <br /> BUILDING TYPE: ©SFR °Townhouse °Duplex DADU °Multi-Family-#Units: °Commercial °Accessory Structure <br /> TYPE OF PROJECT(check all that apply): °New Construction DAddltlon ❑Remodel °Repair OT.t. °Change of Use <br /> ©Modular °Portable ORe-roof °Exterior Alteration °Tank(above ground) °Accessory Structure <br /> °Fence oveer7ft high DRackStorage DPootlHot Tub °Tank(above ground) °Other:Deck Rebuild <br /> DESCRIPTION OF WORK:Replace Existing Deck, like for like:453 Sq Ft ECEI1VE- <br /> MAY 2 5 2023 <br /> CITY OF EVERETT <br /> permit Serviced <br /> ACKNOWLEDGEMEM':T I have reviewed this ap*HcaUon and confirm the informaton contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,end local law.The granting of a permit oft,authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.lam the owner,or l am authorized by The owner of this property to perform the worst for which apphcatksrt Is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of EVereft Official use Only <br /> t 5/24/2023 PERMI <br /> 0 5— <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />