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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: STREET 1550 tr mewlI'E Vi ckv DRPARCEL#: &D G. / /� <br /> £VEgET[ CITY STATE I�i�{sff ZIP 9?20// <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): AVM —THE sr°RE f/'US <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t/LI P /14 r E-s` E,f <br /> OWNER MAILING ADDRESS: STREET l �3( , /iCkt-if 41/4 <br /> CITY ' STATETA wref- I ZIP 98r..t 0 I <br /> OWNER PHONE: 2s�- i(?%zE- OWNER EMAIL: EsTE P141.4fP Y of 4`)44 <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: 'OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ /56 0, 425 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and- equipmentui needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: ////�V'l ��yyS o G <br /> PROPOSED USE OF BUILDING: S'7 e <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other ,YEN <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 1-1' .[` , ,commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: CE 0-40Fr teem? VA <br /> DESCRIPTION OF WORK: <br /> t €m (I vim` /t X LEN <br /> C/JE;C�/E s )1/6-R S'/p.� ,r t/ <br /> ACKNOWLEDGEMENT:1 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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> {� City of Everett Official Use Only <br /> �Q / ' `.. C Q PER 2., <br /> Owner/Authorized Aft Signature• <br /> Date r (Revised 2/8/2021) <br /> V /� <br />