2011 HOYT AVE 2025-09-30 - Laserfiche WebLink

B' -NLDING PERMIT APPLICA" 7N CITY EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal require numb WASHINGTON E' .LrL�,c1p%ies1re9quir4Ir review, then drop off completed application plus all required submittal documents t 0 Cedar Street 2nd Floor Int rop Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServicesOeveretlw . I(WAJtet .g@�jirmits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET i d .t (,r PARCEL#: " °_ Cm /e( e't STATE 4� ZIP �O G 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: OWNER MAILING ADDRESS: STREET a ✓' CITY STATE r� ZIP �I I:-- OWNER PHONE: -jC ,Q0 � OWNER EMAIL: e --X C %4 Ef pc c. CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED):/L-c3A c 'L CITY OF EVERETT BUSINESS LICENSE#(REQUI ED); l2 1 S CONTRACTOR ADDRESS: STREET CriY ( } STATE ZIP �o j CONTRACTOR PHONE: - -3 CONTRACTOR EMAIL: //(i c N:a z 5 r Ct If`o ✓ PRIMARY CONTACT: ❑OWNER GJ'EONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3 ( C s 33 ? 7 r ,� J CONTACT EMAIL: v4I-k-:C e 'C' BUILDING INFORMATION VALUATION OF WORK:$ O C c L ASSOCIATED LAND USE PROJECT#(if applicable): (valuation shall include the prevailing fair ark bor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDI G: L h PROPOSED USE OF BUILDIN HEAT SOURCE: ❑Gas ER161ectric ❑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 ❑ L�Re-roof Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: ACKNOWLEDGEMENT.-1 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WA C. City of Everett Official Use Only PERMIT# /1 4/,/—/ 6 AD0a 3' 'er/ALfthorized Agent Signature Date (Revised 42112022)