5008 23RD AVE W 2025-04-21 - 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 submlltal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.8B10 I(E)everelteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: sTREEt 5008 23RD AVE W PARCEL#: 00644500001300 CITY EVERETT STATE WA zfP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if(ion-residential): LEGAL DESCRIPTION for new construction: Short Plallsubdivislon: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Gary Miyasaki OWNER MAILING ADDRESS: STREET See project site CITY STATE 7iP OWNER PHONE.707-548-1099 OWNER EMAIL: garymiyasaki@yahoo.com CONTRACTOR COMPANY NAME:R&R Foundation Specialist WA STATE CONTRACTOR LICENSE#(REQUIRED):RRFOUFS829DA ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 58143 CONTRACTOR ADDRESS: STREET3409 Mcdougall Ave, Suite 204 CITY Everett STAFE WA ZIP 98201 CONTRACTOR PHONE:4257605077 CONTRACTOR EMAIL:permits@rrspecialist.net PRIMARY CONTACT: ❑OWNER Uv CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4255838062 Alesha Stiekles CONTACT EMAIL:alesha@rrspecialist.net BUILDING INFORMATION VALUATION OF WORK:$26200 ASSOCIATED LAND USE PROJECT# if applicable): (Valuation shall include the preva➢ing fair market value of al labor,materials,and equipment noeded to complete the work,whethor actually pakf or not.) EXISTING USE OF BUILDING:SFR PROPOSED USE OF BUILDING:NO Change-SFR HEAT SOURCE: ❑Gas UElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Conslructlon ❑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) UOther:Foundation DESCRIPTION OF WORK:Installation of helical piles to stabilize the foundation after settling 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 Worst,slate,and/ocallaw.The granting of o permit only authorizes approved work and no deviefions 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 f8.27 RCW and 286.200A WAC. City of F-verett Official Use Only PERMIT# O r/AuthoTiz d Agent Signature 7 Dale!!!/ (Revised 2/&r2021)