11325 19TH AVE SE 2025-04-21 - Laserfiche WebLink

Imo BALDING PERMIT APPLICATA/1V 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 I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION / f PROJECT SITE ADDRESS: STREET 11325 19th Ave SE PARCEL#: 1308262U633"t8B8—L t)k— ci r Everett STATE WA ZIP 98208 SUITE/UNIT#: C310 FLOOR#: 3 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: THE LAKE SHORE AT SILVER LAKE Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Ellen Wang OWNER MAILING ADDRESS: STREET 11325 19th Ave SE CITY Everett STATE WA ZIP 98208 OWNER PHONE:206-832-7742 OWNER EMAIL: CONTRACTOR COMPANY NAME:Home Depot 'l �] WA STATE CONTRACTOR LICENSE#(REQUIRED):to f E 7?-DiaRt'1TY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 ' (001 CONTRACTOR ADDRESS: STREET P.O. Box 105451 CITY Atlanta STATE Georgia ZIP 98201 CONTRACTOR PHONE:770-433-8211 CONTRACTOR EMAIL:HD@nwpermit.Com PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Z OTHER(Please Specify) Permit Agent CONTACT NAME: CONTACT PHONE:206-601-7043 William M i l l h o l l i n CONTACT EMAIL: William@nwpermit.com BUILDING INFORMATION VALUATION OF WORK:$2227.82 '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:CONDOMINIUM PROPOSED USE OF BUILDING:CONDOMINIUM HEAT SOURCE: ❑Gas ZElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ZMulti-Family-#Units: i2 ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ©Remodel ❑Repair ETA. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ZExterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: REMOVE AND REPLACE 1 WINDOW ON THE THIRD FLOOR IN AN EXISTING CONDOMINIUM UNIT, LIKE FOR LIKE IN SIZE, NO CHANGE TO STRUCTURAL OR CLEAR OPEN. 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 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 10/31/22 PERMIT# Owner/Autho d Agent Signature Date (Revised 4/21/2022)