4021 FRIDAY AVE 2025-09-11 - Laserfiche WebLink

BUI' 71NG PERMIT APPLICATIr 1 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 9NFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only PIcEze) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1�% N PARCEL#: O O 8 0 Qo 1 G c)�C) Q Cr1Y -4�-cAA STATE %^� A ZIP t 6--L�E3 SUITE/UNIT#: NJ ; FLOOR#: `� ADDITIONAL LOCATION INFORMATION (if applicable): N TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: *}Q�� t j `p O !S-- Lot No.: (attach copy of long legal description) "� L� CONTACT INFORMATION OWNER NAME: !"11 G�i) VA �l`1 ler `j 2-\o A \. o✓, S OWNER MAILING ADDRESS: STREET a CITY (�.3 �� STATE �-+ 1"l ZIP y OWNER PHONE: 4 2 ) 3 9 e OWNER EMAIL: Ir k V,e W1 c'tZ r�t J�o�Go �vtCQS� • vvf CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED):S�S\'t,O C 86ZR ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (p5 5 22 CONTRACTOR ADDRESS: STREET pal �(G C i — '�3C Sct� p CITY +'1 r1� O O�L STATE W ZIP CONTRACTOR PHONE: 2v(,) -2,S 3 -Lk°t 3 CONTRACTOR EMAIL: t�)St .e> '3k C o/l�SSrV Gr c ,, �a�K oo IG• Lo PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: :2o(,) 3 S3 -kk--1 3�- �� CONTACT EMAIL:`,1516 BUILDING INFORMATION VALUATION OF WORK:$ `f o ASSOCRATED 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: d [- PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric ❑Other t+ !A BUILDING TYPE:)JSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑C ,,r}} ab 20&jcesso tructure TYPE OF PROJECT(check all that apply): ONew Construction ❑Addition ❑ m Reodel XR� I Y[r Ev6ha 11 Use [-]Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory StRemit ServviceCsl I ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other DESCRIPTION OF WORK: -I ACKNOWLEDGEMENT.'1 have reviewed this application and confim,,the info.,mation 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 l 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 PERMI � ) _..0��