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11111111 <br /> 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) J 1rPROJECT SITE/INFORMATION n <br /> PROJECT SITE ADDRESS: STREET ZO cQ/'YI //V��ICG?✓ RCEL#: BAD G' 2 I <br /> CITY (✓ ,/ �� STATE /VA A ZIP ycp/WC'6l I <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):y-� <br /> TENANT/BUSINESS NAME(if non-residential): / //�( STO/?��L� -sr6 Fr? =hicia <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /7v.z f P m, Vet <br /> OWNER MAILING ADDRESS: STREET /23/ ,qa .,1��R ,4 f�G, s�/� <br /> CITY Ell'vE�/� E ^,STATE ,�J Ig9/ij� }�ZIPp 9P e)f <br /> OWNER PHONE: 441. .S —2�2 'r �,cT OWNER EMAIL: ! fl/ij �l—( 7 /�1 e5. (O/Z4 <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: $ SOI�•�Q 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: l' / (VI ST�R 4.E <br /> PROPOSED USE OF BUILDING: 5)4 <br /> HEAT SOURCE: ❑Gas ❑Electric Other ND�� <br /> BUILDING TYPE: ❑SFR ❑Townhouse EDuplex ❑ADU ❑Multi-Family-#Units: 3F? ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): [II New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: CAIELICt`���`T / ' 44'01/A - <br /> DESCRIPTION OF WORK: <br /> �6mOV 44k. C /E&VES esti �'` /O� / � <br /> P'ErnOVe f{L.1 ).,4FT2 #. 2- A.pDRS. <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 /> j11 <br /> s Vi <br /> City off Everett Official Use Only <br /> PEcit <br /> CT?/K: <br /> Owner/Authorized Age n�Signature Date (Revised 2/8/2021) <br />