2612 E GRAND AVE 2025-04-15 - Laserfiche WebLink

BUDDING PERMIT APPLICATIOI 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 PROJECT SITE ADDRESS: STREET 2612 E Grand Ave PARCEL#: 00516859202000 cry Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION f att : nr,L�(� TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (atta�h,�opbof/lotinal des n) CONTACT INFORMATION ��JJ II LLJJ OWNER NAME:Robert& Marta Jacoby CITY OF tVERETT OWNER MAILING ADDRESS: STREET 2612 E Grand Ave Permit Services cry Everett STATE WA ZIP 98201 OWNER PHONE:206-240-1205 OWNER EMAIL: robertjacoby©gmail.com CONTRACTOR COMPANY NAME:Reneau Renovations L LC WA STATE CONTRACTOR LICENSE#(REQUIRED):#RENEARL845DD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: sTREET6609 36th st ne CITY Marysville STATE WA Zip 98270 CONTRACTOR PHONE:425-446-2914 CONTRACTOR EMAIL:jCreneau©yahOO.COm PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-240-1205 Robert Jacoby CONTACT EMAIL:robertjacoby@gmail.com BUILDING INFORMATION VALUATION OF WORK: $20000 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevaihng fair market value of all labor,materials.and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:SFR PROPOSED USE OF BUILDING:SFR HEAT SOURCE: ❑Gas C✓iElectric ❑Other BUILDING TYPE: L1SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑✓Remodel ❑✓Repair ❑T.I. ❑✓Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:Using an existing closet that is partially under the stairs, tdoo r gas water 49eater. (AA -t miY &MS ctopt, fnr c v.c onorto taMM-cvJ 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 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 NIC PERMIT# O-, ner/Authori d Agent Sign er Date (Revised 4/21/2022)