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( ti • <br /> BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETTSUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps©everettwa.gov I aN)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 6 �EO int p[.1 I.I. CRCf, 1 �(!v'Y P1{RCEL#: <br /> CITY()if't /® STATE tit/ ZIP q 2O3 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): / r / s <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> ,+ CONTACT INFORMATION <br /> OWNER NAME: Ai iA i L 0)/ 0Iq L LC <br /> OWNER MAILING ADDRESS: STREET eO) .2 ' Ave St,/f I 1300 a <br /> CITY Se) Tf'L i. STATE ( ZIP q V/D <br /> OWNER PHONE:2 0(9 5e. 7 Z b6$ OWNER EMAILS4 WI SO/tir b A/UJ/3 L by 6 0 WI. <br /> CONTRACTOR COMPANY NAME: /ti - '5/19 V Roo F.)s s1 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED• /2)s) X?J OZZb8 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)3 8 3 3. <br /> CONTRACTOR ADDRESS: STREET P.0 I P O x Z / _ I <br /> CITY /�Ve IDS p yc LC STATE LA.)f1 ZIP qg os <br /> CONTRACTOR PHONE:20b 34 f 2 9S7 CONTRACTOR EMAILTj2)-S fA RA 00 F)4?q e ' 60 1rl <br /> PRIMARY CONTACT: ❑OWNER ,CTCONTRACTOR ❑OTHER(Please Specify) J I <br /> CONTACT NAME: CONTACT PHONE: 2,0 34 ) .2 <br /> 7 J` U (A) MAppt a 1 CONTACT EMAIL:7I2) -S gnp0r/f'` AKA/ �0 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 2q1, 300, 00 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: EGas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: $Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable kRe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> �N'3i)3L� ,. NeA 0 LI is7'Yt S)y� -CI ti> O'le - i f "3 12 <br /> M eHA c GLy / 1 ci o r iz 7po Jc'ooF p i ill • <br /> ivo e, :TAIL Lufa4,s ALL. Nk wt1 �� r)IVL(m i1`I i i4-c JN j 0 y. <br /> /L (AMOR)91117)/ <br /> 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 <br /> 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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> U L` PERMIT# <br /> ner/Authorized Ag-t Signature Date (Revised 2/8/2021) <br /> Z <br />