Laserfiche WebLink
Nom <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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET A 2E7 i19y4lt'fNE OIARCEL#: <br /> CITY RE-Tr STATE W J 5H ZIP 2 gigot <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): 7.71. STO, Ho1F S/ /0(N/ dRg 44E <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT9— INFORMATION <br /> OWNER NAME: Pi�fJ�1� `/1 ( ES/p�6P c '/ <br /> OWNER MAILING ADDRESS: STREET /?5/ t?t C. e 13(/? 4 /-� <br /> CITY f� �j/Ri 77 STATE ZIP 9 zr <br /> OWNER PHONE: 31:Z5--2 �;2—4/9zi OWNER EMAIL:E T7c.� ',9 9448:3C0-- Y/INC,Ot Olev,i, <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: Jit OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: f '5...-2.5.";2— /9) 2 <br /> CONTACT EMAIL: _57-E-74t)p /L/p yi , C 144 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 0Ca 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: CYlV/1// ,S7O 1I T GE <br /> PROPOSED USE OF BUILDING: 5.4 Al <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> / <br /> !1�® <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 6alCommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair CIT.!. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure dd <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: CNkS.1:: .1-e REM011,1 k <br /> DESCRIPTION OF WORK: <br /> 16 dvl a VE 14I LD FT,z ,J/D /o.DEyeS <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 /> 41‘ PER <br /> fea <br /> --a(4 <br /> Owner/Authorized Age Signature 4 Date (Revised 2/8/2021) <br />