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• <br /> BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 I(E)everetleps+?everettwa.gov((W)everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 5008 23RD AVE W PARCEL#: 00644500001300 <br /> cmr EVERETT STATE WA zip 9$203 <br /> SUITEIUNIT#: 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:Gary Miyasaki <br /> OWNER MAILING ADDRESS: STREET See project site <br /> CITY STATE ZIP <br /> OWNER PHONE:707-548-1099 OWNER EMAIL: garymiyasaki@yahoo.com <br /> CONTRACTOR COMPANY NAME:R&R Foundation Specialist <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):RRFOUFS829DA CITY OF EVERETT BUSINESS LICENSE H(REQUIRED): 58143 <br /> CONTRACTOR ADDRESS: srnEEr3409 Mcdougall Ave, Suite 204 <br /> cnv Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:4257605077 CONTRACTOR EMAIL:permitS C@rrSpeCial1St.net <br /> PRIMARY CONTACT: ❑OWNER (]CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:4255838062 <br /> Alesha Stickles CONTACTEMAIL:aiesha@rrspecialist.net <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:S26200 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall Include the provenly fair market value of at labor,materials,and equipment needed to complete the work.whether actually pan or not.) <br /> EXISTING USE OF BUILDING:SFR <br /> PROPOSED USE OF BUILDING:NO change-SFR <br /> HEAT SOURCE: OGas ['Electric ['Other <br /> BUILDING TYPE: OSFR ['Townhouse ❑Duplex ❑ADU ❑Multi Family-#Units: ['Commercial ['Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ['New Construction ['Addition ❑Remodel ✓[]. Repair OT.I. ['Change of Use <br /> ['Modular ['Portable ORe-roof OExtedor Alteration Drank(above ground) ['Accessory Structure <br /> OFence over 7ft high ORackStorage ❑PooilHot Tub ['Tank(above ground) ✓ClOther:Foundation <br /> DESCRIPTION OF WORK:Installation of helical piles to stabilize the foundation after settling <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.lam the owner,or t 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 /> iPERIviv City of Everett Official)Use Only <br /> Af/ 191//( <br /> 7 /off <br /> 0 rlAuthoriz d Agent nature Date (Revised 2021) <br /> 1/�. <br />