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LDING PERMIT APPLICA'.. JN c U E <br />CITY OF EVERETT PERMIT SERVICES 0 E <br />EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requiremen}s a d nurpr0of�Riesrequired fot'reitlew, <br />WAS H IN GTON then drop off completed application plus all required submittal documents to 3200 Cedar trLx2t F120take Droo'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 'v' i=HE IT <br />PROJECT SITE ADDRESS: STREET 2601 Oakes Ave PARCEL #: 00439160900100 , <br />CITY Everett STATE INA Zlp 98201 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction. Short Plattsubdivision: EVERETT PLAT DP ELK 609 D-00 Lot No LOTS 1 & 2 (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Kim Gale <br />OWNER MAILING ADDRESS: STREET 2601 Oakes Ave <br />crry Everett STATE WA Zlp 98201 <br />OWNER PHONE: (360) 921-0193 <br />OWNER EMAIL: kimkalkofen@icloud.com <br />CONTRACTOR COMPANY NAME: Matvey Foundation Repair <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): Matveci991 cb <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 056264 <br />CONTRACTOR ADDRESS: STREET 18915 16th Ave S <br />CITY Seatac, WA STATE WA ZIP 98188 <br />CONTRACTOR PHONE: (253) 327-1650 <br />CONTRACTOR EMAIL: permits@gomatvey.com <br />PRIMARY CONTACT: ❑ OWNER W1 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />C i e rra Pinson <br />CONTACT PHONE: (206) 698-3977 <br />CONTACT EMAIL: permits@gomatvey.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 35,200 ASSOCIATED LAND USE PROJECT # (if applicable): <br />(Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) <br />EXISTING USE OF BUILDING: Four Plex <br />PROPOSED USE OF BUILDING: No Change <br />HEAT SOURCE: ❑✓ Gas []Electric []Other <br />BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ZMulti-Family - # Units: ❑Commercial ❑Accessory Structure <br />TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑Remodel WIRepair ❑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 />Underpinning existing residence foundation. <br />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 <br />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 <br />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, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />01 /27/2023 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # �1 �� <br />(Revised 412112022) <br />