1111 WETMORE AVE B 2025-08-19 - Laserfiche WebLink

NM BLINDING PERMIT APPLICAVfN • 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)425-257-88101(E)PermitServices@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET r(I\ Q,-("Thtic Ave, PARCEL#�� gcO y'ti (B-1 t3 1 160 CITYv STATE �V ZIP cw ab 1 SUITE/UNIT#: 13 FLOOR#: 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) CONTACT INFORMATION �,� OWNER NAME: \..wx\v3" \ x\- / (31 - ' T i`.]v`r 1"1 . OWNER MAILING ADDRESS: STREET 1 t 11 WC INAt^(-ki Ilk \I.e._ CITY 4 sLc e STATE ZIP GJI)1 • OWNER PHONE: 5310 k-V\CN - IA"-\ OWNER EMAIL: 3DkN11'YWG GX\� ThC AA i C y(r) ^ CONTRACTOR COMPANY NAME: �\m Ct" i Uk b-ne'\ WA STATE CONTRACTOR LICENSE#(REQUIRED):Ste-of t t.L.! t,4-1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)St9(Ak'ieNle(li CONTRACTOR ADDRESS: STREET[\\ , 1 �.Q rATSC.e, N\J CITY E V Qf STATE \/4 ik• ZIP at% ao I CONTRACTOR PHONE: 5N�e.., 0\S CY C CONTRACTOR EMAIL: 5& -' O•$ t I'9 ( PRIMARY CONTACT: 4)WNER E CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK: $ 16 I-t)t Z3 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: ��.. PROPOSED USE OF BUILDING: r 1'CNcll\�.A_ A.,'6a HEAT SOURCE: ❑Gas IIectric ❑Other BUILDING TYPE:'gSFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercia t]Accessory Structure TYPE OF PROJECT(check all that apply): ONew Construction DAddition Wemodel Repair DT.I. Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ClAcces1so`ry Structure ['Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub DTank(above ground) tOther: 7,4n'ti ,z y ," r.:4-Y T'J . 4 JO. DESCRIPTION OF WORK: c-- IL5-C\-V,VA� pkv' IS v\e) ,NO SAIALVuLkikk -e5 . D ECEINE NOV 01 2023 J ACKNOWLEDGEMENT'I have reviewed this application and confirm the information contained herein is true and correct. Work dr, u (� s�c�mply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviatiohl s fi. 6 o �� ting from the Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to��b I�r`4 �plication is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# � -`'` , ()()CV191 �Z3 1 ( — ooLt Owr9e#Authorized Aggent S nature Date (Revised 4121/2022)