Laserfiche WebLink
lfks rc o��. 1 ? LE©Env,� uvEE) <br /> BUILDING PERMIT APPLICATION FEB 1 9 2023 <br /> CITY OF EVERETT PERMIT SERVICES ��// `0 <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements aP btc As r review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 &ti t eepv; Drop Sox. <br /> CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)everettwa.govipermrls <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: s-rneet 0 6 t 3 4oT ti PL,EveyKe-TT PARCEL#: OOg cM 1 10000 i f 2pc <br /> CITY e/ege.';T STATE zIP -!$20 <br /> SUITE/UNIT#: 6 )3 FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): N • <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: /vG Lot No.: irj/ , (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: •. IM U S(!iv G'V FSerrA-( b. • <br /> OWNER MAILING ADDRESS: sTREET 6 1 3 4-0-rri Q L/ -� <br /> CM( ev6G <br /> TT STATE WA- ZIP Is 201 <br /> �l <br /> OWNER PHONE: 7 ( 33-7G� <br /> I L 4.4-3 OWNER EMAIL: lA(Ikaa lc(anr22 ggrn Rut eOrrl• <br /> CONTRACTOR COMPANY NAME: T}-(0—Q G'(Z, %A LL, J>O ThC t'..JQve V <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): "//1}- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): NIA • <br /> CONTRACTOR ADDRESS: STREET /ll/A <br /> CITY 1‘1/4 STATE ti/A ZIP Ofilk. <br /> 1 i <br /> CONTRACTOR PHONE: 1 3-7 I '41-3 CONTRACTOR EMAIL: 14 'PRIMARY CONTACT: Cl OWNER ❑CONTRACTOR NrOTHER(Please Specify) Det eri4E-K.- • <br /> CONTACT," NAME: CONTACT PHONE: 2 Gi?j 3 f S7 027 1 <br /> w l(t.(mV Prick Kik CONTACT EMAIL: (,u l (e9 hl 22 ie.a1 l r Corr?, <br /> BUILDING INFORMATION I <br /> VALUATION OF WORK:$ /Clo 0 ' ASSOCIATED LAND USE PROJECT#(if applicable): <br /> prevailing <br /> (Valuation shall include the fair mai4 et value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: 5(Af6c-t-6-- pAol lL,-f ICSI()&^rCC <br /> PROPOSED USE OF BUILDING: A'D tl LT e)of FtRsr6timi47Ft-aoR., 9FR. 0,1 kS t 1 <br /> HEAT SOURCE: OGas giElectric ❑Other &PA'Mlf:7 cttILL-TM* t>F &Ci yEl`/C.i) <br /> BUILDING TYPE: I fSFR OTownhouse ODuplex OADU ❑Multi-Family-#Units: L]Commercial OAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction DAddition gRemodel ORepair CIT.!. ❑Change of Use <br /> Modular OPortable ORe-roof []Exterior Alteration DTank(above ground) DAccessory Structure <br /> OFence over 7ft high ORackStorage [Pool/Hat Tub []Tank(above ground) DOther: <br /> DESCRIPTION OF WORK: <br /> tr O/N�J y-{'o An. rtu54.14 - ce lac, z ( r aor-,s. `P� t4, ,ram <br /> ,0,,.,, `-fig, <br /> c,SA N Dn5 WC 44, fl u <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.I am the owner,or am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors 18.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 0aiagf2,0�3, 2.3t,j -- over. <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />