3516 ROCKEFELLER AVE 2025-03-24 - Laserfiche WebLink

BUILDING PERMIT APPLICATION 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 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET �/, t/� PARCEL.M CRY -� STATE ZIP SUITEIUNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short PlaUsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: K y , �t;1n t^l OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: t \ . �«�. .I Q l.�r=t f CU CONTRACTOR COMPANY NAME:WA STATE CONTRACTOR LICENSE#/(REQUIRED): AT L LZ I OF EVERETT BUSINESS LICENSE#t(REQUIRED):C0 S _� CONTRACTOR ADDRESS: STREET C) ( Q CRY A P\ STATE 21P CONTRACTOR PHONE: CONTRACTOR EMAIL: A } PRIMARY CONTACT: ROWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: C( 1 3>1`6 n,;r-7 CONTACT EMAIL: ± y BUILDING INFORMATION VALUATION OF WORK:$ U ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair rip rRet value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: []Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU []Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check al/that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. []Change of Use LIModular ❑Portable ❑Re-roof []Exterior Alteration ❑Tank(above ground) ❑AccessoryStructurre L1Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: Q 00 G DESCRIPTION OF WORK: ACKNOWLEDGEMENT.•l have reviewed tills 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 he authorized in writing from the Building Official before bet .authorized under any circumstance.t am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and!comp rich the ale Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT#/ Owl /Authorized Agent Signature Da e (Revised 412112022)