2227 GRAND AVE 2025-09-11 - Laserfiche WebLink

BUILDING PERMIT APPLICATk jN 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 tor 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov j(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2Z2Z � PARCEL#: 00¢39 j¢82.0j C0 CITY EVF9E7r STATE 4V, . ZIP 20,/ SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: OF Lot No.:0-vo-LOT 14,4/�r2C^F407-15 CONTACT INFORMATION OWNER NAME: CAPL6 %AA�-AfGj �E 6,412 JOHN JIB V4t,5AI OWNER MAILING ADDRESS: STREET r yy Tr.Z��!G G*Z 6,QAN1>R VE. �� /A e n CITY 5✓ STATE ZIP 7 ♦�`�, OWNER PHONE: (937) Z38-f-666, OWNER EMAIL: tyltIlleAgAile Q ! �• tout CONTRACTOR COMPANY NAME: &IZa OL11Y Q F_S WA STATE CONTRACTOR LICENSE#t CCC7l'---1J00 08ZJA CITY OF EVERETT BUSINESS LICENSE# O 5 5*6 c7 CONTRACTOR ADDRESS: STREET 8 6e1 60B65 90AD CITY J'A/DHOMl Stf STATE WA • zip B Z I O CONTRACTOR PHONE: 1CONTRACTOR EMAIL: OI%n CP3 D G . Aet PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) AV1WRt?PA4CW • 161*9S TllAWI ARrrt CONTACT NAME: L' r CONTACT PHONE: C13 7— bARY JL2HAj MV UEA CONTACT EMAIL: 1KV11eA&b1e 2 aMail• GO!?') BUILDING INFORMATION VALUATION OF WORK:$ • 00 "ACC 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: d r la d da ed ana -14o be- ^EwiD e PROPOSED USE OF BUILDING:/{✓ D-e"/L Wi fh bIt?e eo ZrV S/CR. HEAT SOURCE: []Gas ❑Electric ❑Other NONE BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial SAccessory Structure TYPE OF PROJECT(check all that apply): INNew Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof El Exterior Alteration ❑Tank(above ground) XAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) Other: DESCRIPTION OF WORK: R.E'Pt,Ac,E W/ N5W 6AMGE -AU tAJ� bR-G5-ZL WAY 'Z D SCR. 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 1 comply with the State Contractors Law 16.27 RCW and 296200A WAC. oe City of Everett Official Use Only Z//Zy/(4- PERMIT^ `j- [2-2022 L Owner/Au or' ed Agent Signature Date (Revised 42112022)