8909 CORBIN DR 2025-09-10 - Laserfiche WebLink

o" PERMIT APPLICATION D ECEOVE BUILDING CITY OF EVERETT PERMIT SERVICES c 1 ryrynn''�� EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and ber cjFD5es�rAuit r revie , WASHINGTON then drop off completed application plus all required submittal documents to 3200 C a treet 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.88101(E)everetteps@everettwa.gov I(W)ever / i TT (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Permit Services PROJECT SITE ADDRESS: STREET b , PARCEL#: .- r CITY W -t4-- STATE A- ZIP ID SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plattsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: / Me R S Q OWNER MAILING ADDRESS: STREETCo-bin jam. CITY STATE WA ZIP 9 OWNER PHONE: gm '�1'5196OWNER EMAI ` CONTRACTOR CO PANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: AOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: Lt de 174 V/-e,: O� BUILDING INFORMATION VALUATION OF WORK:$ ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and eq,ipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: l I PROPOSED USE OF BUILDING: G1 / HEAT SOURCE: ❑Gas XElectric ❑Other BUILDING TYPE:VSFR nTownhouse ❑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) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: 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.1 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 WAC. City of Everett Official Use Only PERMIT# O horized gent Signature Date —� (Revised 21812021)