11622 SILVER LAKE RD 2025-04-18 - Laserfiche WebLink

BOLDING PERMIT APPLICA*N IgrECEOVIE CITY OF EVERETT PERMIT SERVICESEVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requiremed number of copies required r •gview, WASHINGTON then drop off completed application plus all required submittal documents to 3eda �tk et F ntake r p Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gW)eve a twg..4ov,hits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY OF FVPRETT PROJECT SITE ADDRESS: STREET 11622 Silver Lake Road PARCEL#: 009600m1� bt Services cnT• Everett STATE WA ZIP 98208 SUITE/UNIT#: 56 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): Silver Shores MHP TENANT/BUSINESS NAME(if non-residential):First Commercial Properties LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Jake Bucher OWNER MAILING ADDRESS: STREET 2020 Maltby Road, Suite 7, Box 109 CITY Bothell STATE WA Zip 98021 OWNER PHONE:206-773-7469 OWNER EMAIL: Jake@fcpnw.com CONTRACTOR COMPANY NAME:LND Services WA STATE CONTRACTOR LICENSE#(REQUIRED):BERRYS*055J4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 60293 CONTRACTOR ADDRESS: STREET 8319 189th Street Court East CITY Puyallup STATE WA ZIP 98373 CONTRACTOR PHONE:253-335-9640 CONTRACTOR EMAIL: PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-773-7469 Jake Bucher CONTACT EMAIL:Jake@fcpnw.com BUILDING INFORMATION VALUATION OF WORK:$101,000 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:Single Family Manufactured Home PROPOSED USE OF BUILDING:Single Family Manufactured Home HEAT SOURCE: ❑Gas ✓❑Electric ❑Other BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair LTA. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub LiTank(above ground) ✓❑Other:Manufactured Home DESCRIPTION OF WORK: Replacing and old existing mobile home with a new home in an existing Mobile Home park. ACKNOWLEDGEMENT:1 have reviewed this application and confine 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 .. y aVa6,) ��30 5Oun lze gent Signature o (Revised 4/21/2022)