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• <br /> E BILDING PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1817 Hoyt Ave PARCEL#: 00438036900900 <br /> cln Everett STATE WA zip 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Jay Henderson <br /> OWNER MAILING ADDRESS: STREET 1817 Hoyt Ave <br /> cin Everett STATE WA ZIP 98201 <br /> OWNER PHONE:425-478-3756 OWNER EMAIL: threewheel@msn.com <br /> CONTRACTOR COMPANY NAME:R&R Foundation Specialist <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):RRFOUFS829DA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 58143 <br /> CONTRACTOR ADDRESS: STREET3409 McDougall Ave Suite 204 <br /> cITY Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:425-626-4841 CONTRACTOR EMAIL:barbara@rrspecialist.net <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-626-4841 <br /> Barbara Stasiak CONTACT EMAIL:barbara@rrspecialist.net <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $44107.50 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:SFR <br /> PROPOSED USE OF BUILDING:SFR <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑✓Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ERe-roof ElExterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> EFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> crew will install helical piles and stabil locs to stabilize and lift foundation to maximum <br /> practical recovery <br /> 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 <br /> 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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ,e5a,LeC`A'a. 2/24/2022 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />