2105 MCDOUGALL AVE B 2025-08-12 - Laserfiche WebLink

um az BODING PERMIT APPLICA•N 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 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 210 5 ML i;k: •;(2 A ie— PARCEL#: - 13,/Ia /wai ciTY EV - J P STATE w;,R ZIP 5 gzO/ SUITE/UNIT#: C17 FLOOR#: _ ADDITIONAL LOCATION INFORMATION (if pli- le): TENANT/BUSINESS NAME(if non-residential): r D I©II O j✓ I 3 LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (a copy :. ,oyar aescrlpaur,t CONTACT INFORMATION 'S 3 6 LU14 OWNER NAME: / ''4-7-)-7%E4) 3: t-}a,� / CITY OF FVFRETT OWNER MAILING ADDRESS: STREET /'ff'203 Sun73/c% 1 v. A •c�`� �" Permit Services CITY -eCtff -- / STATE 1414 ZIP 7g/3 OWNER PHONE: WGi -4,5�--j•��j0.� OWNER EMAIL: • d.Pcrf✓1hru399i'I?tii•/. W1k7 CONTRACTOR COMPANY NAME: /le'C/4 14?"itrt:j ivol- %LC .' WA STATE CONTRACTOR LICENSE#(REQUIRED): FLk FP(_q. 0i 1C- , TY OF/EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET /9,303 SL3,iiy'side ' _ A CITY Sec( /.� STATE WA ZIP 78/3 3 CONTRACTOR PHONE: 2,06 / ""�� .-S 107 CO RACTOR EMAIL: �7�C/ JGrla f/,j 0,9twClrl-GL1/ii PRIMARY CONTACT: RoWNER ❑CONTRACTOR El O71-IER(Please Specify) CONTACT NAME::: J��, //CONTACT PHONE: `7Q�- Gj 57 /4.4,��t,,z,kl f74c-J ' CONTACT EMAIL: h Lp it-,4-ri-..00 0)i'1ciC( .Cc' --1 /BUILDING INFORMATION VALUATION OF WORK:$ 70I 0 0 0 / ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor, :terials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: D'v'rt-e-X PROPOSED USE OF BUILDING: Cot.W Yuicx-te.r-C-c:rwr tv� d..4'1-e x `0 1 prin c ipi up I If-- cOs1J 2— AU)5. HEAT SOURCE: ❑Gas ®Electric Ed Other BUILDING TYPE: ®SFR ❑Townhous: ❑Duplex NADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that app ): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. &Change of Use ❑Modular ❑Portable ❑Re-ro. ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackS orage ❑Pool/Hot Tub ❑Tank(above ground) DOther: DESCRIPTION OF WORK: 1, 0v1 7-10S M •ZsuccLQ AV`t.- : Co iu-6-r-€ ' ,i1-ir- `�y A. Yl,P -Dori 0« co trc+rs-i dup1,x ft, P` 4)c�c1� un(4- (Fix cc I) and 2 AD0tS (F--Loors 2 t aA €wLr^: -- N ) z -E, , t3 7 ,-,iSr , is DCS iiDtf .-"N S ACKNOWLEDGEMENT::I have reviewed this application and confirm the information contained herein is true and correct. Woi .one 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.Dev. .ns 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 th' pro.pro v. .perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAG. j� Q ' City of Everett Official Use/O�Only authorized Agent r na ure // �� 9 9 Date (Revised 4/21/2022)