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1611 BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL 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(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT^ SITE INFORMATION <br /> PROJECT SITE ADDRESS: sS /'t.1aRRILL (/oR1Gfc pjCwy PARCEL#: 2 <br /> CITY E ,t Tl STATE (Ai A ZIP g e -q o 3 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): AV 7-6C H 7-ycf <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: J1/W S.V 1 c d 1/V 1 LLC <br /> OWNER MAILING ADDRESS: STREET Oi ' iv--04f'er f 5J/j e /3 00 y �p <br /> CITY Se14�LY,/s STATE Y1 / ZIP q0 j o y <br /> OWNER PHONE:2 0i) 3-0 7 264.' OWNER EMAIL:Sj9 mS011. b t/v WBLb. co 144 <br /> CONTRACTOR COMPANY NAME: -57)9 it-7200Y jiiet j c," <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED5; /jT A 10ZZ0B CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):30 3 3 <br /> CONTRACTOR ADDRESS: STREET 0 , t K 4 <br /> CITY PAN E AS LC STATE ZIP q <br /> 6 e3 y�I <br /> CONTRACTOR PHONE:206 3q/ ,Z 'I..SV CONTRACTOR EMAIL;/ jt 0 01✓,I9F1(nn� /" v der <br /> PRIMARY CONTACT: ❑OWNER $CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 1 CONTACT PHONE: 7 Ob 3Gjy/ ,,/ <br /> �U1 W //L11u tW�fJ CONTACT EMAIL:"TA)_sJ/9RA00F)/•g e/ insw, G D jii <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ iq 1,61 Sr C D ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing f it 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: XCommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable C IRe-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 /> .ANY; tr 3.SO4/Y64) r 04-91iS 740- Sl © Vert` if CX1s7miii R.U, g , <br /> niecin v1G Ltd/ 17AG/1 0 l°V1 iL rip 7 OoF Sy 7q7)1 <br /> )VniC: I A141..14h4s 41.1. w priir`rnvis 4a rh ;toL cto i)Jq Gv/Zo/A.N® L <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 /> an I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> FV 33 2E24 Z1d3 �' 031- <br /> wner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> I/� <br />