1617 RUCKER AVE 2025-08-20 - Laserfiche WebLink

BUILDING PERMIT APPLICATION 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET RuckerAve, PARCEL M () CITY Ev ere STATE ZIP .O SUITEMNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): Iq TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: L ✓ OWNER MAILING ADDRESS: STREET Rucker V cny E G r e STATE-WAZIP 20 OWNER PHONE: 20 5 ,q v OWNER EMAIL: L/ ajJ. co CONTRACTOR COMPANY NAME: r WA STATE CONTRACTOR LICENSE#(REQUIRED): IT OF EVERETT BUSINESS LICENSE#(REQUIRED): I C-P�'I i CONTRACTOR ADDRESS: STREET /�9j2 —j/ F)• 2CRY CV2 STATE ZIP 2V 99 CONTRACTOR PHONE: j 6p52, 6a Z CONTRACTOR EMAIL: PRIMARY CONTACT: MOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: ` CONTACT PHONE: 0. film �j^f�L CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK:$ ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fW market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: 5E PROPOSED USE OF UILDING: S FR HEAT SOURCE: 19Gos ❑Electric ❑Other _ ❑Accesso Structure BUILDING TYPE: SFR ❑Townhouse []Duplex ❑ADU ❑Multi Family #Units: ❑Commercial ry TYPE OF PROJECT(check all that apply): El 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: R C�i m nee u%rlw uil� U 01 2024 �F E�ERETT C�Pe�rnit SeN�ces 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# � 2 z G U Owner/Authorized Agent Sign re ate (Revised 412112022)