528 MADISON ST 2025-09-26 - Laserfiche WebLink

BUILJING PERMIT APPLICATIOK 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 528 Madison St PARCEL#: 00393300001200 CITY Everett STATE WA ZP 98203 SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plattsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Josh O'Neil c/o City of Everett OWNER MAILING ADDRESS: STREET 802 E.Mukilteo Blvd. CITY Everett STATE WA ZIP 98203 OWNER PHONE:(425)328-4659 OWNER EMAIL: JONeil@everettwa.gov CONTRACTOR COMPANY NAME:Burton Construction WA STATE CONTRACTOR LICENSE#(REQUIRED):BURTOCIO38MZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 053839 CONTRACTOR ADDRESS: STREET280 SW 43rd St,Bldg 4 CITY Renton STATE WA ZIP 98057 CONTRACTOR PHONE:509-468-4932 CONTRACTOR EMAIL:EBenjamin@burtonconstruction.net PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:(206)542-3734 Heidi HelgeSOrl/CrlSty Weller CONTACT EMAIL:cristy@h2darchitects.com BUILDING INFORMATION VALUATION OF WORK:$115000 ASSOCIATED LAND USE PROJECT#(if applicable):N/A (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:Single-family residence PROPOSED USE OF BUILDING:Single-family residence HEAT SOURCE: ❑Gas ✓❑Electric ❑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:Interior remodel t0 existing Single family residence F-E OW E RDRk,4 J 1,A 3 4 2923 CITY OF EVERETT 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 0191py elgnad by Held)Helgew DN:O-US.E-Heldldh2de Mlroats—.O-'H2OArdtllxWt° PERMIT# Heidi Helgeson`D`-�°"-"°"'"" °° 12/27/23 Z.n:agree tb the temp defined by Ibe pbcement°t my 5lgruure bn ade dmmerd Date:2023.122710:26:21.08W 1 Owner/Authorized Agent Signature Date (Revised 412112022)