1612 ROCKEFELLER AVE 2025-04-17 - Laserfiche WebLink

• . - n. 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 I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1toJ Rockertiv 1 /li PARCEL#: 7 �,3J O� 7- 0 CITY V'eref1' STATE wa ZIPq g70/ SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): Evcrel± al' 1_ -/UO LEGAL DESCRIPTION for new construction: Short Plat/subdivision. j, t e f BI k 3' Lot No.: 224-, (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:jbra dph fstr) OWNER MAILING ADDRESS: STREET cci°e CP1 adcll 'tcf },,rr UCIITY STATE ZIP OWNER PHONE: SLc, Con-t i - OWNER EMAIL:(S'C COn a-- CONTRACTOR COMPANY NAME: R4R -Fou datipn OrcialiSt WA STATE CONTRACTOR LICENSE#(REQUIRED):RePotirs02q04 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET pid e ma`'j f e V1 cG1J ctr CITY .„ ri STATE It)Cf ZIP/giO) CONTRACTOR PHONE:/42�-I LoO W7 7 4)07-- CONTRACTOR EMAIL: a J tJh6 h'SP6'G4G!I Sl-• net PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CO TACT(NAME:r ( {� ( CONTACT PHONE: y25- a- 0492- r} L . ha &fickl{J CONTACT EMAIL: 0'�6 �j-Ir�pP2Ja /�Ur J'Le'"[ BUILDING INFORMATION VALUATION OF WORK:$31,(,OO 00 ASSOCIATED LAND USE PROJECT#(if applicable): (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: SFV PROPOSED USE OF BUILDING: 00 C,`aW g6 HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: /.11.FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑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) ❑Other: SCRI DEPTION OF WORK: DESCRIPTION llahOil v+- pi he! cals,asmb►► roc, cvnnei1106 p r aril sleel Ch1,hntl 10 5') ktIIze like Q, f nili ciatio' Orcr crni ii43. 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 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT 2 l �� el I 67/27afte 7 wner/Authori Agent Signature D (Revised 4/21/2022) V.2._