613 40TH PL 2025-04-22 - Laserfiche WebLink

e-kou.s-k• I/RECEIVED ENE BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT FEB 1 9 Z0�3 SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and�n+u�m- r/o {rt I iew, 'WASHINGTON then drop off completed application plus all required submittal documents to 3200 CeCilJtrget 4*J 'f hit op Box. CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)a Et tmilikv 1d�C�S (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 40 T D,PARCEL#: /��/©/� l"I oo�o CITY Eve-Re-TT t/ STATE V A ZIP Ck SUITE/UNIT#: FLOOR#: /1.//k ADDITIONAL LOCATION INFORMATION (if applicable): AJ TENANT/BUSINESS NAME(if non-residential): I,J/A- LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/// - Lot No.: 1) .( (attach copy of long legal description) n CONTACT INFORMATION rV I OWNER NAME: iJ JI\IbT'(f &1JMD • OWNER MAILING ADDRESS: STREET 3 -1"'l PL. CITY 1J �l \ STATE to c zip T --- OWNER PHONE: 17 I 3 7/ 9'443 OWNER EMAIL: w1l (dy-Li 2.2.- zJ et[r�Gw-r; CONTRACTOR COMPANY NAME: vie OvdiJ&& weLL, pcf `Tt.te- WA STATE CONTRACTOR LICENSE#(REQUIRED): /r( - CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): fJ/A CONTRACTOR ADDRESS: STREET 01; // CITY i �''�• STATE/ //A_ ZIP IV/4 , CONTRACTOR PHONE: cf7J •�i 7( qI�C4-Zj CONTRACTOR EMAIL: N fik• s PRIMARY CONTACT: ❑OWNER CONTRACTOR i_'rOTHER(Please Specify) ftK. CONTACT NAME: CONTACT PHONE: 21s;3 31$ 021 �,v t (()' s f )- CONTACT EMAIL: t i BUILDING INFORMATION VALUATION OF WORK:$ _ / � I ,(7-e,ei 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: 1Q- PROPOSED USE OF BUILDING: 'rf' * r� T {-fc�t'1� ('r� MA{I�/ .tx'i �,19r :i✓1 irASCePitell& HEAT SOURCE: ❑Gas Wlectric ❑Other /65 F3l14144 ra A &(-Ae& gtskrvt=L;) BUILDING TYPE: qc1SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition XRemodel ❑Repair ❑T.I. ❑Change of Use (Modular ❑Portable ❑Re-roof !._Exterior Alteration jTank(above ground) ❑Accessory Structure L]Fence over 7ft high EiRackStorage L Pool/Hot Tub ETank(above ground) ❑Other: DESCRIPTION OF WORK: • `{cr,--4,t- .�, '-tom K ul rbQ •-6 frjfctizo 10 1'790r.. r 6304 Q- 11^4_ 911eNk Kzi>kr1 - ka e_i a +roC:p,.% td.f` > UJCL S L -f- s(.� Jk .64.‘ 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# Vg/O2//20 Owner/Authorized Agent Signature Date (Revised 4/21/2022)