8015 BROADWAY 2025-09-09 - Laserfiche WebLink

BViLDING PERMIT APPLICATIuN 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)everetteps@everetlwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: SMA , ro G PARCEL#: O l crry v/te rff STATE W A ZIP R Z O SUITEMNIT M FLOOR#: D1 19A1A CATION INFORMATION (if applicable): TENANT/BUSINESS NAME(il non-resident' ): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: j Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: V SVI OWNER MAILING ADDRESS: STREET CITY �(,``�,V � STATE ZIP q OWNER PHONE: Zi!5 (e — S (p OWNER EMAIL: �/—. p c' Z) j , C CONTRACTOR COMPANY NAME: J C-On S-}K Al e3 n CO vtl V1 WA STATE CONTRACTOR LICENSE#(REQUIR D): L �� CI F EVERETT BUSINESS LICENSE#(REQUIR CONTRACTOR ADDRESS: STREET 1 C) C 1 Q 32 ctTy ,t STATE ZIP •V�� CONTRACTOR PHONE: -0 "q2Z— Q 03 CONTRACTOR EMAIL: q CGC)on'19a Go PRIMARY CONTACT: ❑OWNER tKCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3(o 0- a2Z 531 3 Yoh aN V\x-L— v CONTACT EMAIL: Jc"ev1 0,AG47. a)(AQkyyw` IC�yn I UILDING INFORMATION VALUATION OF WOR $ E>5 600 - OCR JASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the pre fling fair market value of all labor,materials, nd equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: U5� PROPOSED USE OF BUILDING: 'p HEAT SOURCE: ❑Gas *lectric ❑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: `, 1W W*k�� 1 I_Cam , 0( a 1 1/V1G+wi u 1 G VGA l 61��In ,A�� ca�S+ ✓► 5 VIa l oc l� ru.c i-u�l •�v�d «S lc�, � y , rkvrl� �x�,S�t�, �',�y e G �p 3 �'►I,�t 0��5 .J e i d al16h � Id W ed yt j 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 laty.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building OM I before beingjauthhounder any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, am r, 1,41 1 PE" and I com with the State C Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Ow rl horized A e Sigt Lure Da (Revised 21812021) r7 W 2,1_060 �� /�