2232 12TH ST 2025-12-12 - Laserfiche WebLink

BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINOTON 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 PROJECT SITE ADDRESS: STREET u,'lj2 'L'Th PARCEL#: CITYcl-V4,"�71ff— STATEyj ZIP SUITEIUNIT#: FLOOR#: 1-1 ADDITIONAL LOCA�T'IO/N� INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Abs c t(` f( C LEGAL DESCRIPTION for new construction: Short Plat/subdivision:kW(ILI r(� t No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 1Se0. OWNER MAILING ADDRESS: STREET 2,th - CITY STATE ZIP OWNER PHONE: (p0— eAco OWNER EMAIL: C� h� ��GM 1 IW C CONTRACTOR COMPANY NAME: " S uz_ WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6>15300 CONTRACTOR ADDRESS: STREET h L 116 CITY STATE ZIP ob 4 CONTRACTOR PHONE: _ w— ,3(*,B t CONTRACTOR EMAIL: )Z> (( j50rj ne,i%A6o v e4 eorn PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 9 OTHER(Please Specify)I1 Cyr CONTACT NAME: CONTACT PHONE: 0� J esS� � CONTACT EMAIL: ( _ et j�iGbU��1 1caM A BUILDING INFORMATION VALUATION OF WORK:$ 11 cob ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing felt market value of alhlabor,materials,and equlpment needed to complete the work,whether actualy paid or not.) EXISTING USE OF BUILDING: .t 1 PROPOSED USE OF BUILDING: — '�N HEAT SOURCE: ❑Gas AElectric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ;gRepalr ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: _ DESCRIPTION OF WORK: Iw'kwl\ ,l Dtcc CA,%(\� oUk COtke'f\ JO>S--S UY\c� SiS{e..CiNJ 0A N)J jo�S6 ACKNOWLEDGEMENT.-I have reviewed this application and confirm the Information contained herein is live and correct.Work done pursuant to this permit must comply with current federal,state,end 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(his 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# O er/Authorizec Agent Signature Date (Revised 412112022)