1722 100TH ST SW 2025-11-07 - Laserfiche WebLink

BV" DiNG PERMIT APPLICATf - N V R T CITY OF EVERETT PERMIT SERVICES 1 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 .'ROJECT SITE ADDRESS: STREET U Ei- (,. L 1-7 7'2 DOS S1 S PARCEL#: QUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION if a licable ?A i c °A W h-1 S 'ENANT/BUSINESS NAME(if non-residential): _EGAL DESCRIPTION for new construction: Short Plat/subdivision: Rt� Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: e.Qi A \i I UJ F L-L(� )WNER MAILING ADDRESS: STREET yam_ L SOX .f:,:T clry l�Fsu°� i \%E i�9 STATE '1n1 A ZIP —Q )WNER PHONE: ZC _ C ._ wr; OWNER EMAIL: 'ONTRACTOR COMPANY NAME: (,�PA !A STATE CONTRACTOR LICENSE#(REQUIRED): �YAFi\F6fl7 JW CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): I 7 8�- :ONTRACTOR ADDRESS: STREET cITY i�Ai'C STEU�7\1S c STATE -ONTRACTOR PHONE: LjZS� �L,�j—�r_s L� CONTRACTOR EMAIL: a 'EU j C(::"11r , _RIMARY CONTACT: 11 OWNER ❑CONTRACTOR OTHER(Please Specify) „j I i_ ��it [Nlr_ 7 ONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING INFORMATION ALUATION , T WORK: I 24, , rV G C ASSOCIATED LAND USE PROJECT#(if applicable): aluation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) -XISTING USE OF BUILDING: T r ROPOSED USE OF BUILDING: ,Cr.1=$r D I\iCF_ =AT SOURCE: ❑Gas ;Electric ❑Other JILDING TYPE: PSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure YPE OF PROJECT check all that a l ( PP y)' 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: ZSCRIPTION OF WORK: Pilo P�S`p S i-r 0 A St ;KNOWLEDGEMENT.f have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with .-rent 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 ':/ding Official before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, d I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# ner/Authorized Agent Signature / Datd (Revised 412112022) Z