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• • • <br /> �! BUILDING PERMIT APPLICATION <br /> • <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number or copies required for review, <br /> WASHI NGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)428.287.8810 I(E)everetteps©everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 3ry(�G'1T 0/7�- ��,p (� ,�_ PARCEL#: <br /> CfY e-VG S STATE V.T 114 Q ZIP % 04!) <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION(If applicable): <br /> TENANT/BUSINESS NAME(If non-residential): j3e,CANJ (9 y p) (244 WEST- <br /> LEGAL DESCRIPTION for new construction: Short PlaUsubdNtsion: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> V Ei <br /> OWNER NAME: - ZEir L.L. i? Nf& /)V7--e0#LJT <br /> OWNER MAILING ADDRESS: STREET <br /> 3 /0�7 . &'I j / f E <br /> cm' v S-12-& n STATE w 4 ZIp e 2 0 j <br /> OWNER PHONE: OWNER EMAIL: rG, h(c9-e_J h A• O <br /> CONTRACTOR COMPANY NAME: PIl elST _ \iO K, J OQ J G <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):ril SrEJtlO5`9QL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET 2'1 J 40 T1'f gT_ �j CITY �r • E r STATE L,I/Q/J ZIP 9 Q 2_6 1 <br /> CONTRACTOR PHONE0 ZS, 2 i- 72.2.(4. 'CONTRACTOR EMAIL: M nsrem e1C- &6d;u @ ruts.Co ,►i <br /> PRIMARY CONTACT: ISKWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: dos- 253- (3 Tr ,a y <br /> RtreJ tD I CONTACT EMAIL: rciad h e d k 4.O <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ (sO [ASSOCIATED LAND USE PROJECT#(if applicable): <br /> NaluaUon shall irtctude the providing fair msikot a e c%tl tabor.m aterfels,end owment needed to ccmpfale the work,whether actually pals or not) <br /> EXISTING USE OF BUILDING: 5 E' J tO e- f f; 45 <br /> PROPOSED USE OF BUILDING: S19-f✓j C <br /> HEAT SOURCE: ❑Gas ❑Electric. ❑other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ODuplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check�ltall that apply): ONew Construction ❑Addition ❑Remodel ORepair OT.I. OChange of Use <br /> ❑Modular [Portable mRe-roof?[Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> OFance over 7ft high ❑RackStorage OPool/Hot Tub OTank(above ground) I70ther <br /> DESCRIPTION OF WORK: <br /> 6 NICit &c sJ-1 0s ?oeCi N3,5 (I 14, r) <br /> ACKNOWLEDGEMENT:I have reviewed this application and oonflrm the Information contained herein Is true and correct.Work done pursuant to this penal must comply with <br /> current federal,stale,and local law.The granting of a pemtlt only authorizes approved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Bullring Official before being authorised under any circumstance.l em the owner,or lam authorized by the owner of this property to perform the work for which application lI made, <br /> and l comply with the Slate Contractors Law 18.27 ROW and 208.200A WAO. <br /> CO of Everett Official Use Only <br /> PERMIT# <br /> 2-/014 —o65 <br /> Owner/Authorized Agent Signature Date (Revised 2/0/2021) <br /> 7i <br />