3220 LOMBARD AVE 2025-10-06 - Laserfiche WebLink

BUII -ING PERMIT APPLICATIO'' p EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requiremen nur{t�epofjgpieuired f r iew, WASHINGTON then drop off completed application plus all required submittal documents to 32 9 dar e t n88 F take Box. CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov I everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION TT PROJECT SITE ADDRESS: STREET 3 _0 t �/> PARCEL#: q3 y l es CITY _J STATE W ZIP SUITE/UNIT#: 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: L12 V0, OWNER MAILING ADDRESS: STREET CITY t' STATE `l ZIP 62 OWNER PHONE: — `�%/-/ f - c �� . OWNER EMAIL:.;I�l d J i .D �YtG� � ',. e' � CONTRACTOR COMPANY NAME: t �� — U . WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): { CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: 7j6- - �j CONTRACTOR EMAIL: c,' o �r PRIMARY CONTACT: OWNER I ONTRACTOR THER(Please Specify) CONTACT NAME: CONTACT PHONE: --rm' ko U\ CONTACT EMAIL:-- BUILDING INFORMATION VALUATION OF WORK:$ 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: ,I .) JAA I PROPOSED USE OF BUILDING: HEAT SOURCE: HFR lectric ther BUILDING TYPE: ownhouse I 11uplex DU I ;K ulti-Family-#Units: 1 ommercial ccessory Structure TYPE OF PROJECT(check all that apply): ew Construction ddition "emodel Wepair L hange of Use Rodular �ortable e-roof xterior Alteration ank(above ground) ccessory Structure ,nce over 7ft high ackStorage ool/Hot Tub ank(above ground) ther: DESCRIPTION OF WORK: r fl uv\ 0,0210 C> C rL)+4e'\, -t-cQofJS a v'c) ct rr; Qr� 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.if am the owner,or 1 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 PERMIT# Owner/Authorized Agent Sig ture Date (Revised 412112022)