9820 18TH AVE W 2025-08-20 - Laserfiche WebLink

BUILDING PERMIT APPLICAIIIIIIIN 5 ZZ0 Z—O t,2 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 (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE 'IN FORMATION PROJECT SITE ADDRESS: STREET g2,Z0 k1,'\ hve.„ VVS PARCEL#:00 f1M'I 000OO 100 CITY E_NfkrOk- STATE V1 ZIP (+9)2,04 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): , LEGAL DESCRIPTION for new construction: Short Plat/subdivision:i'00V►1VA�L� pCot o.:C© v C(aTrach copy of long legal description) CONTACT INFORMATION OWNER NAME: Vjcv(�� C, k/At Q C 50 h OWNER MAILING ADDRESS: STREET qsw, (we_ vl CITY" ,i,r STATE ry r` ZIP q Lo4 OWNER PHONE: l-r)..5 -3-2,o Lkk4 S OWNER EMAIL: , h. tp CONTRACTOR COMPANY NAME: C7 U.)f lJe A _ WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR $,OTHER(Please Specify).j1cj,r x" 5k-f uv chic.\ CONTACT NAME: 1411 �c � Nr\-k:t M t CONTACT PHONE: " l t'k.42-17 (oC c�\.(Ln CG'M CONTACT EMAIL: fv..1ChIv\�►i1��Q p610,400 co BUILDING INFORMATION VALUATION OF WORK:$ 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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: LISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial QAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction addition 26emodel ❑Repair ❑T.I. ❑Change of Use EModular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) alccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) Bother:e cc e. 3OJ & DESCRIPTION OF WORK: C � -�v,trx&0�. U`l 1�.��" 1M t'(� C.e 'er \ . VQ `A-eA-( 1-`(tll'�elvt \o �� w��t^,n�5• 1 !E©IIIVLfl 0 AUG162022 CITY OF EpVryE'RPTT PP pursuant to Q&mplywith ACKNOWLEDGEMENT:(have reviewed this application and confirm the information contained herein is true and correct. Work done ursuant to I 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 comp with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PEIRT# A- wn Authorized Agent Signatur Date (Revised 4/21/2022) V V ^ O/'-co its