Laserfiche WebLink
1 <br />I <br />ECEOVE <br />BUILDING PERMIT APPLICATIODMAY 16 2023 <br />EVERETT SUBMITTAL INSTRUCTIONS: See CITY OF EVERETT PERMIT SERVICES CITY OF EVERETT <br />applicable submittal checklist for submittal requirements an review. <br />AS N Ton then drop off completed application plus all required submittal documents to 3200 C d�12c n oor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: sTPG . V- CPi KFPS VEl f'v PARCEL#: C('4--)S-k3C(pG 3 :�-CC <br />IT \JC P-- C T T STA,r \A, A Z,P '9 ��Cf 1 <br />SUITEIUNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction Short PlaVsubdtvision i9L L-A< 3 C, C- Lot No (attach copy of long legal descnp6on} <br />CONTACT INFORMATION <br />OWNER NAME: LA-G T 1 tk I�t 2tr Cri V—C tP, <br />OWNER MAILING ADDRESS: STREET I G ;�nL7 (�� 1C L S t t �1 f) L) G <br />CITY C-- V t=. lt�ri 1 TT STATE `A/U ! ` ZIP <br />OWNER PHONE: +-7- 5 4 O `_7 S 19 <br />1OWNER EMAIL: C-1 CIA f r c" C^' Ckt cc-. co -VI, <br />CONTRACTOR COMPANY NAME: S C lrr— <br />A STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET <br />CITY STA, ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: XOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: S v <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ tj <br />ASSOCIATED LAND USE PROJECT # (if applicable): <br />(Valuation shall include the prevailing far market vak�e of all labor, materials, and equipment needed to complete the wore, whether actually pad or not j <br />EXISTING USE OF BUILDING: S F P, <br />PROPOSED USE OF BUILDING: NC Ct+ h N Cie 5 <br />HEAT SOURCE: ❑Gas lectric ❑Other <br />BUILDING TYPE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: _ ❑Commercial ❑Accessory Structure <br />TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑Remodel )(Repair ❑T.I. ❑Change of Use <br />❑Modular ❑Portable []Re -roof ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure <br />❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other <br />DESCRIPTION OF WORK- <br />v..e a.;) v-� a ✓ , c e .�-� w �` °1' ` 4n 5 <br />air � g,t <br />�D Must. <br />ACKNOWLEDGEMENT 1 have reviewed this application and confirm the information contaned herein Is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law The granting of a permt only authorizes approved work and no deviations 0 wrahom, Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance i am the owner. or / am authorized by the owner of tills property to perform the work for wtuch application is made. <br />and I comply with the State Contractors Law 18.27 RCW and 296 200A WAC <br />City of Everett Official Use Only <br />j PERMIT # n^G O_ O q <br />Owner/Authorized /2 nt Signature Date (Revised 4fl2022) <br />