1026 LOMBARD AVE 2025-04-16 - Laserfiche WebLink

III I NEN Liz 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 I(E)PermitServices@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET ✓a_' $ `rl 141 het✓`el Ave PARCEL#: 00 y.3 q 07.6 Yr9 '�LOC CITY ftriorfft" f� STATE tj A ZIP 9 8 O SUITE/UNIT#: FLOOR#: a ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): V a-(n ytf LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: 3,..'* r�k. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 111 ,pc Gtrrk e / It. j,1.(A., DQ A / 1 OWNER MAILING ADDRESS: STREET SO I a„, I- C" `mLt-k 1-f-ro STATE (A) A ZIP g8;L7S /J, OWNER PHONE:t 5 ` �/�C e-/6-(J "1- C7 1( OWNER EMAIL:'-2-ndaa A l l S c,C�- p inc_o.c„," ' . CONTRACTOR COMPANY NAME: 5 f) 0� r'r`a/ CO ✓ i WA STATE CONTRACTOR LICENSE#(REQUIRED):59 C -86k6CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):t t P i- , CONTRACTOR ADDRESS: STREET SO( yv ,tL 5-� `' CITY/rn_r_l_Ai / l ee STATE r /1 1 ZIP lig 9_13 CONTRACTOR PHONE:Li 3- -xL•l q- Ct9/s/ CONTRACTOR EMAIL:✓yl') it,/ I�� /�5 'ri co . (" en„ PRIMARY CONTACT: g OWNER ❑CONTRACTOR CI OTHER(Please Specify) `� CONTACT NAME: CONTACT PHONE: Li 0- ' pp-/Y`'��i �- �t� i t �//e Ii If t � l` CONTACT EMAIL: /�yi tin /; /l<-� Sr� L3 1 ('r1 • f1? I I //! d to BUILDING INFORMATION VALUATION OF WORK:$ al ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market�a of a of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: Val tea..,.,, -j' ''-el C.:A._f•¢," - -ea_'Yh , !I PROPOSED USE OF BUILDING: C,J4 fictq,.t:J,r HEAT SOURCE: ❑GasElectric ❑Other / BUILDING TYPE: ❑SFR ['Townhouse ❑Duplex ❑ADU Multi-Family-#Units: t/ ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ['New Construction ❑Addition ❑Remodel ERepair ❑T.l. ❑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: E 1 DESCRIPTION OF WORK: t a.�r5 0v,O. sifie re 0r6 APR 11 2024 J, 'ke P � tew 00,,, ,S / CITY OF EVERETT Cri4-,'cal ga-fetS eq Ltd (�ue fD (,)o-fer ot.4,14,5e/COS�` efic Permit Services CJ ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and conect.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only /r/9—(14 PERMIT# .g 'ufti,orb Owner Authorized Agent Signature Date (Revised 4/21/2022)