1313 75TH ST SW 2025-04-07 - Laserfiche WebLink

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 1 (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1313 75th St SW PARCEL#: 28041100100100 cITY Everett STATE WA Z,p 98203 SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Middle Earth Holdings LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Middle Earth Holdings OWNER MAILING ADDRESS: STREET 1415 75th St SW CITY Everett STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL: tiandry@hellonenergy.Com CONTRACTOR COMPANY NAME:Andersen Construction WA STATE CONTRACTOR LICENSE#(REQUIRED):ANDERCC822BW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 1041696740010001 CONTRACTOR ADDRESS: STIEET5601 6th Ave S, Ste 550 CITY Seattle STATE WA ZIP 98108 CONTRACTOR PHONE: CONTRACTOR EMAIL:akartic@andersen-ConSt.com PRIMARY CONTACT: i]OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425_495_4215 Tyler Landry CONTACT EMAIL:tlandry@helionenergy.com BUILDING INFORMATION VALUATION OF WORK: $20,000 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:light Industrial PROPOSED USE OF BUILDING:light Industrial HEAT SOURCE: OGas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: FICommercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair OT.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: DESCRIPTION OF WORK:Fill-in Of pit permlted Via B2208-108 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 1 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# Owner/Authorized Agent Signature Date (Revised 412112022)