11517 MERIDIAN AVE S A, B 2025-10-24

131 DING PERMIT APPLICAT N �� CITY OF EVERETT PERMIT SERVICES D EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirement d numberofncopies required f r iew, WASHINGTON then drop off completed application plus all required submittal documents to 32 dar et 981712&23take Box. CONTACT INFORMATION: (P) 425-257-8810 I (E) PermitServices@everettwa.go ) everettwa.gov/permits (wau - Mck4hkbfilyPlease) .r PROJECT._SITE,'1NFQRMAT19N PROJECT SITE ADDRESS: STREET 11517 MERIDIAN AVE S PARCEL #: 005736-00 -003- CITY EVERETT STATE WA ZIP 98208 SUITE/UNIT #: A & B FLOOR #: 1&2 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) CON TACT'INFORMATION OWNER NAME: CHAPMAN TRUST OWNER MAILING ADDRESS: STREET 5911 112TH PL SW CITY MUKILTEO STATE WA ZIP 98275 OWNER PHONE: 425-615-3938 OWNER EMAIL: eva.chapman889@gmail.com CONTRACTOR COMPANY NAME: BELFOR WA STATE CONTRACTOR LICENSE #(REQUIRED): BELFOUG99OBJ CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 039176 CONTRACTOR ADDRESS: STREET4320 S 131 ST PL, SUITE 100 CITY SEATTLE STATE WA ZIP 98168 CONTRACTOR PHONE:206-632-0800 CONTRACTOR EMAIL: JEFFREY.LEGG@US.BELFOR.COM PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑✓ OTHER (Please Specify) STRUCTURAL ENGRS: DEGENKOLB ENGINEERS CONTACT NAME: BIANCA CASEM (DEGENKOLB ENGINEERS) CONTACT PHONE: 206-499-5918 CONTACT EMAIL: BCASEM@DEGENKOLB.COM , BUILDING "INIPO.RMATION VALUATION OF WORK: $ 400000 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: DUPLEX, 2-FAMILY RESIDENTIAL PROPOSED USE OF BUILDING: NO CHANGE 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 ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other: DESCRIPTION OF WORK: REPAIRS DUE TO FIRE DAMAGE TO INCLUDE: R&R ROOF STRUCTURE, R&R OF INTERIOR FINISHES AND INSULATION THROUGHOUT THE BUILDING, R&R SELECT WINDOWS AND DOORS, R&R DAMAGED EXTERIOR FINISHES AS NEEDED, RECONSTRUCTION OF PORTION OF THE EXTERIOR DECK 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 / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. Digitally signed by Bianca E. Casem Bianca E. Casem*bd-Ddgenko Engin errs, CN Bial ca E. Casem 8/30/2023 ,�i;gDate:i2023.08.30 18:15:31-07'00' Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # f% P v/0 q _QC� (Revised 412112022)