6215 ROCKEFELLER AVE 2025-09-30 - Laserfiche WebLink

BUILG..4G PERMIT APPLICATION 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 2 PROJECT SITE ADDRESS: STREET v2p G e RVt PARCEL#: OOLig5000 JOIOOO crr' Eve1�J STATE ZIP 8�3 SUITE/UNIT M FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANTlBUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) 1 CONTACT INFORMATION OWNER NAME: Qay1QS Mej I OWNER MAILING ADDRESS: STREET U Zj Y CrTy '\/Cytt� STATE ZIP OWNER PHONE: OWNER EMAIL: Gomos mtj'coo e O ta t - Loh, CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET cnY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: %OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ll Tf-"/j GJ"12-gD12 y, M CONTACT EMAIL: QYIOS YY?_, I d O}t I G ft- h0h2noii 1 -COM ��11 BUILDING INFORMATION VALUATION OF WORK:$ I� OO • 00 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: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas ❑Electric nOthe, 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) > 4ccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub []Tank(above ground) ❑Other: DESCRIPTION OF WORK: Qui1d'n V � ]qr�20/ detacv,ed s1jed pasifriar of pYinc�pal b�ildi� � abUi�ing 41112�. p [ C�IE0M�I �+ MAR 0 2 2024 ACKNOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and correct.Work done pun4nTtgthQFrr�r jI O rEVY�, yTT current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must fir��tiJlfP�the Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform he o i a is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# �U(v5 l ei c`t 3-�I 2aZ y F� 03J (�l Owner/Authorized Agent Signa ure Date (Revised 412112022)