1903 JACKSON AVE A, B 2025-10-24

B&DING PERMIT APPLICATON Et i E I t CITY OF EVERETT PERMIT SERVICES �( 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) PermitServicesO-everettwa.aov I (W) everettwa-aov/nermits (Blue or Black %nk Only P/ease) PROJECT; -SITE: INFORMATION , PROJECT SITE ADDRESS: STREET 1903 Jackson Ave PARCEL #: 00545002801900 clTy Everett STATE Wa zlp 98203 SUITEIUNIT M FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: - (attach copy of long legal description) C [N�ORM�T10F1e OWNER NAME: Adis Zizak OWNER MAILING ADDRESS: STREET 1104 178th st SW Unit A clTv Lynnwood STATE Wa zlp 98037 OWNER PHONE: 425-268-,2515 1OWNER EMAIL: napandesign@gmail.com CONTRACTOR COMPANY NAME: Napa Homes LLC WA STATE CONTRACTOR LICENSE #(REQUIRED): NAPAH HL798J M CITY OF EVERETP BUSINESS LICENSE #(REQUIRED,): 64947 CONTRACTOR ADDRESS: STREET11044 178th st SW Unit A c,Tr Lynnwood STATE Wa z,a 98037 CONTRACTOR PHONE:425-268-2515 1CONTRACTOR EMAIL: napandesign@gmail.com PRIMARY CONTACT: DOWNER ❑✓ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Adis zizak CONTACT PHONE:425-268-2515 CONTACT EMAIL: napandesign@gmail.com 1 _ . ..,. .. a. .... BUILDING 1NORMifTIONs�' VALUATION OF WORK: $ 500 0.00 'f SSOCIATED LAND USE PROJECT # (if applicable) (Valuation shall include the prevailing,r market value of all labor, mat rials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF BUILDING: SFR PROPOSED USE OF BUILDING DupleX- A HEAT SOURCE: ❑Gas ❑✓ Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑✓ Duplex ❑ADU ❑Multi -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 '- El Exterior Alteration ❑Tank (above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other: DESCRIPTION OF WORK: F We are proposing to demolish the existing SFR, and build a duplex on that lot. E": h E 0 D� NOV - 9 2023 -RETT ACKNOWLEDGEMENT.., / have reviewed this application and confirm the information contained herein is true 1. and correct. Work done pursuarfl"taFWAm5i4s*tfi9y"Gvith 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. l 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 1Z PERMIT # f-'�—> � c.� 6 r J 0Z-o , // / 3 /Z 377 — Ia Owner/AiGthorized Age~ ature Date (Revised 412112022)