8004 BROADWAY 2026-03-04 - 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, 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 PROJECT SITE ADDRESS: STREET' (;�('.� &i)�/?t t PARCEL#: CITY ,- STATE ZIP SUITEIUNIT 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: OWNER MAILING ADDRESS: STREET (L 12 (;t r' l CITY V L%� STATE _41114 OWNER PHONE: �j 7 —)y OWNER EMAIL: ,�(j /'.3 6 9 IliS G'L c�G CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET ` CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK:$ v ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailin it market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING. G L' PROPOSED USE OF BUILDING: 14 a HEAT SOURCE: ❑Gas ❑Electric []Other re) 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. El Change of Use ❑Modular ❑PortableRe-roof ❑Exterior Alteration ❑Tank(above ground) []Accessory Structure El Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub []Tank(above ground) ❑Other: DESCRIPTION OF WORK: F R• 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# _ �\7 Owne Authorized Agent Signatu Date (Revised 412112022)