1004 LANE PL 2025-09-30 - Laserfiche WebLink

BUILDING PERMIT APPLICATIUN EVERETT CITY OF EVERETT PERMIT SERVICES 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)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET Q L 4 "L PARCEL#: CITY STATE Zip SUITE/UNIT M 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: I OWNER MAILING ADDRESS: STREET -77 CITY \ �G STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: � WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE Zip CONTRACTOR PHONE: CONTRACTOR EMAIL: „C PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK, ` ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the pr ailing fair market value of bor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF B DIN PROPOSED USE OF BUILDING: 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 E[]Fence ' ! Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: L�(IVY' lr1-9 Ell DESCRIPTION OF WORK: Ve-'mb\1\ol vll�\ afN L APR 17 2023 CITY OF EVERETT Permit Services 22 A`3Cx 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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only P MIT# c — — 23c�E ---bto 3 Owner/XirtfForize4 Agent Signature Date (Revised 21812021)