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NMI <br /> LI BIDING 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 i i j - j .,.j_ C= r e-,,\,`c- >T I-- PARCEL#: <br /> CITY C to 6-' y-P--- STATE ZIP <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME (if non-residential): F Try (. 4aE A-RH l Li L <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (--- i'1rl, bfr `f-- AlPIS Cf' Lsiv 5e% IA_k , ' <br /> OWNER MAILING ADDRESS: STREET f (3 'f._�-e_ ,vo_ l) (— <br /> CITY �vo ra-f,-E. STATE k A ZIP �j )0OWNER PHONE: 6 4-3 2 . 1c3 i OWNER EMAIL: V <br /> CONTRACTOR COMPANY NAME: <2 i4 <br /> c., <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: 0 OWNER CONTRACTOR )THER(Please Specify) blvI �ISW eTi i (3' ,i y"4L, r`.; <br /> CONTACT NAME: CONTACT PHONE: 2 o a, 6`.i 4_ 5- 2.2 <br /> CONTACT EMAIL: ei, fli K..i : i 9 v ii...el 1 , to-41.44 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ C.'. C V ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment neede to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:" �,^ y <br /> l_r2i it i tviAl k 1Cabtilw_ - t.tetirl,,,,i L.Vl(t F' e- td )-1i-ti <br /> PROPOSED USE OF BUILDING: 11-0, <br /> 1 <br /> HEAT SOURCE: )as lectric )ther <br /> BUILDING TYPE: ,FR . - r'luplex r--DU lulti-Family-#Units: commercial .ccessory Structure <br /> TYPE OF PROJECT(check all that apply): lew Construction _,ddition riemodel repair I f.I. _hange of Use <br /> lodular ortable .e-roof xterior Alteration ank(above ground) ,ccessory Structure <br /> 'ence over 7ft high ,ackStorage 'ool/Hot Tub ank(above ground) )ther: <br /> DESCRIPTION OF WORK: <br /> 1 -t 0 C---v 113+—r—t,.t L�t t0 I-A n Vie) Aduti4-ckfrk:i:1 l4ow, -_. <br /> L re_ c_ -(oVi <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 /> PERMIT# f5z 110 -o. i <br /> Owner/Authorized Agent Signature ate (Revised 2/8/2021) ,` <br /> /Z <br />