4020 HOYT AVE 2025-10-06 - Laserfiche WebLink

BUI' -)ING PERMIT APPLICATIC 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)everetteps@everettwa.gov I (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET ZO,/ �Yi. /a- PARCEL#: CITY 6(/ei�j x STATE (�4 ZIP SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANTiBUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 1ioG�d�1�',' Ol/� GIU/ Lt'('--� OWNER MAILING ADDRESS: STREET /wo �Dy/ I fve CITY i?�r STATE W; ZIP OWNER PHONE: �206- ` 71 2 -711- OWNER EMAIL: CONTRACTOR COMPANY NAME: 060[/7 z�r WA STATE CONTRACTOR LICENSE#(REQUIRED): OWHCr CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OGa`I�l CONTRACTOR ADDRESS: STREET y`Oaa y1 /�t/tl CITY STATE ) ZIP -7ed7 o/ CONTRACTOR PHONE: %✓y- 'ice'- C/53� CONTRACTOR EMAIL: ��%/�l/U�a( /Gt/ G/Jr�/%• Co%Y PRIMARY CONTACT: ,Q OWNER DONTRACTOR THER(Please Specify) �/� «✓ ✓�� v// y��'� «Y� CONTACT NAME: CONTACT PHONE: gPo416pl Z-U r6v CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK: $ ;S ✓ Ov 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: !"CT /D PROPOSED USE OF BUILDING: /C�,1 C7- /,4/ /ald �u/1 HEAT SOURCE: as 1Z lectric ther BUILDING TYPE: FR I ownhouse uplex ,% DU ulti-Family-#Units:_ ommercial ccessory Structure TYPE OF PROJECT(check all that apply): ew Construction ddition % emodel epair .l. /' hange of Use odular Flortable e-roof erior AlteratioRank ank(above groundEther....... cessory Structure ence over 7ft high ackStorage ool/Hot Tub (above ground) : DESCRIPTION OF WORK: YE u �7 J'N 1 1 2022 Awe II `' RAILf 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.l am the owner,or l 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 18.27 RCW and 296.200A WAC. I City of Everett Official Use Only PERMIT# % — , ✓ 1_2 B2 112 Je Owner/Authorized Agent Signature Date (Revised 21W2021)