2120 PACIFIC AVE H AND H BODY SHOP 2025-04-17

/1 ® BUILDING PERMIT APPLICATIc 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 V/g'2/ PC,6, y�L /Vie PARCEL#: CITY ye(,{ !J ///// STATE �� ZIP /r.M^/ // SUITE/UNIT#: FLOOR#:(moo/(=G ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): /7 CYO is -2A O/ yt/L// LEGAL DESCRIPTION for new construction: Short Plat/subdivision: ',(ai,y t Av - Lot No.: ✓ (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: R j y j9/. iy7 OWNER MAILING ADDRESS: STREET SIC y i'h- S1-' .4 - CITY /! `�r��!7/ STATE 14 //n ZIP /n r r) OWNER PHONE: 4,2p y 2G)/3 OWNER EMAIL: , _acs 4�czc-Cy (,) pr9 P 4'97 CONTRACTOR COMPANY NAME: r� J ,f//%'� V am 1 ,i.31 cliA9 1d/r it"Y 1 �1or � WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 63 )1)1 CONTRACTOR ADDRESS: STREET Z/2 j/42.-: QrL9 '� CITY b�U` at STATE ZIP U_///V 7/' CONTRACTOR PHONE: 4,✓ 73r ,2 /i CONTRACTOR EMAIL: /"_/9 dxef y7J`/.�vc()P2 PRIMARY CONTACT: Lf OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:9/tom / Ybp9,01-,---,, ,CONTACT PHONE: 4�5/J ^,/f}- //3 v'J r CONTACT EMAIL: /I /% r vc D body C7 Y�G„`frU--eQ�I BUILDING INFORMATION VALUATION OF WORK:$ 60i NO ASSOCIATED LAND USE PROJECT#(if applicable): ITV 1,9,9) —P'G l (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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas FE lectric DOther BUILDING TYPE: DSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: DCommercial DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction DAddition ❑Remodel ❑Repair DT.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof DExterior Alteration ❑Tank(above ground)�❑Accessory Structure ❑Fence over 7ft high DRackStorage DPool/Hot Tub ❑Tank(above ground) L�Other: p71� a_ezi-A' DESCRIPTION OF WORK: Rini- go,21,_ im-rm.//,,s-2,-,,__ i_- E- CEEIMED MAY 2 5 2023 CITY OF EVERETT Permit Services 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 e d 296.200A WAC. City of Everett Official Use Only e Z / f PERMIT# 3 O 06./�j ner/A thorized Agent Signature Date (Revised 4/21/2022)