1326 55TH ST SW 2025-08-20 - Laserfiche WebLink

Ism _DING PERMIT APPLICATA"I 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)everetteps@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: sTREET 1'j t - 5 17-4- STE- V--T PARCEL#: Opg,- 00000, ,L1OD STATE L3A,. ZIP 952,0-2- SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: 2Jck (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: TLC.LeR- i �A�r p 'GARS OWNER MAILING ADDRESS: STREET Vba - 55' smb- 5.W- CITY E r- STATE pA, ZIP 82o.J OWNER PHONE: (s.12 - OWNER EMAIL: I2'e+e.41e0n(10n\'-1e yv.U.ti\ • Cann CONTRACTOR COMPANY NAME: k 61,4314At CA,As- utc—tt„y� l WA STATE CONTRACTOR LICENSE#(REQUIRED): W6H-f"(� j-. t41. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �j p`6 55 CONTRACTOR ADDRESS: STREET f(o2I2. go�l� GQ c j'� W-I - , SA L E 2-1LP cm, Mt STATE W A, ZIP �=.1 L_ CONTRACTOR PHONE: (442�� Sag- 233o CONTRACTOR EMAIL:fi,1„-Wt/nt„O46O on tc. # %\n,,a\. Cov✓1 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) SVAr— CONTACT NAME:'o,-464--RS CONTACT PHONE: (Zv� 22-5-DOCo� - L.CIl 4 CAZ b2AY-m 44 CONTACT EMAIL:joucyc rv,0A ✓tu- i- co j. Gco✓.) BUILDING INFORMATION VALUATION OF WORK:$15 rjoo ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair mlarket 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: 11, HEAT SOURCE: Gas ❑Electric ❑Other BUILDING TYPE: SISFR ❑Townhouse ODuplex ❑ADU EMulti-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ®Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high DRackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: LotaE-42_ u-I AcuCrrKeNntO f We Ler I,G sEtaMteE,NaT: thee av lawi eTwhee dg trhainst iapplication r mado cnolyn fairumth torieinsf oarpmparotioven dc ownotrakn aendd h neor edine viatirounes a tnhde rceofrroremc.D Wevoirakt iodonns em puusrts furasnt tb teo athuitsh poriezrmedit imn uwsrit tcnogm fprolym w tihhe Building ffi al before i g autho'zed un ranycireummstance.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 mpl with t e t e Contra tors aw . AC. City of Everett Official Use Only PERMIT# [ 0 dx2.10 6 >D-D3-ZoZ2 Ow er/ t rize Agent Signature Date (Revised 2/8/2021)