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• <br /> ri <br /> BUILDING PERMIT APPLICATION <br /> g� CITY OF`EVERErrPERMITSERVICES <br /> i► R SURMItTAL INSTRUCTIONS:See applicable submiitai checklist for submittal requirements and number of copies required for review, <br /> wAstrun tote then drop oft completed application plus atl'required submittal documents to 3200 Cedar S€rest 2nd Floor Intake Drop Boca <br /> CONTACT INFORMATION:(P)425.257,8810 t(E)everetteps@everethva.gov((W)everetiwa.gov/permits <br /> (Mayor Black Ink Only Neese) PROJECT SIITE:INFORM/01 <br /> PROJECT SITE ADDRESS: meet 133 0r CO I� AvL PARCEL 1: <br /> CITY tpedse-1.t STATE ' 2, q AQ I <br /> SUITEIUNIT 4: FLOOR 4: ADDITIONAL LOCATION (if applicable): <br /> TENANTIBUSINESS NAME(if non-residential): e.,l q P14,9'C A.( t L z�LEGAL DESCRIPTION tar new constriction:Short Piausubd vision: ( Lot is (attach copyet tong legal description) <br /> CONTACT INFORMAIION <br /> OWNER NAME: <;t14 (i 14 <br /> `OWNER MAILING ADDRESS: srrteer Lit'2 2. 3 µ AL,e , 'v a 2 O 2-. <br /> j WYV {'�f teem( .STATE 14/4... ZIP -i 'C(. L <br /> OWNER PHONE: 4-_ -I. ( -O, 3 OWNER EMAIL: Ti-'r"t- ' +toyt+tg�a . ( O {w CO In <br /> CONTRACTOR COMPANY NAME: 5ttf34 t t � e"x vs <br /> WA STATE CONTRACTOR LICENSE ll(REOUIR ): .O'Utr t$ . TY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET 24et1iP t it W <br /> Say td1 .., STATE WAS` ZIP I8'01,lri <br /> CONTRACTOR PHONE: VC,,- rf - 40 CONTRACTOR EMAIL: 1.r e love..ef.,e,..froa•Pelj -C64"1, <br /> PRIMARY CONTACT: efOWNER Q CONTRACTOR CI OTHER(Please Specify)a <br /> CONTACT NAME: CONTACT PHONE: 6 ) i'V if- 4/2.60 <br /> i,vtwv., 0 CONTACT EMAIL: ` AID <br /> Sou .. c roo r' •oc t-‘._ <br /> OUILD!1NG INFORM 0i <br /> VALUATION OF WORK:$ 5>1 3g 3- ASSOCIATED LAND USE PROJECT S(if applicable): <br /> Vat t:Me dig t eleethelueveang Lair Merkel vatue et a r.matettais,and equipment needed-to ooroprow tito week whether ameny paid DT ea) <br /> EXISTING USE OF BUILDING: V A(-4 At- <br /> .. <br /> PROPOSED USE OF BUILDING: 1 s;Cy£ ike.p <br /> it <br /> HEAT SOURCE: CIGas Atectric °Other_, <br /> BUILDING TYPE: °SFR °Townhouse CIDuplex QADU COMuili-Family-d Units °Commercial (Accessory Structure <br /> TYPE OF PROJECT(check all that apply):_ t]NewConstruction °Addition LiRemodel °Repair CIT.!. CJChange of Use <br /> °Modular ClPortable l4Re-roof °Exterior Alteration Drank(above ground) °Accessory Structure <br /> °Fence over lit high ORackStorage °Pootlt-tot Tub °Tank(above ground) C lother <br /> ESCRIPTION OF WORK: <br /> (ee, 1 7.t... . ) <br /> ACKNOWLE GEMENr:I have reviewed trlsappecatktitowl confirm the fnfonnatket contained herein is tree artacorteet.Work done pursuant to this permit musty ontptywitt <br /> current ferfem4 srete.-endtocattatx the ipentlfig rot ape wit on y riii(hoWtesOpen:wed work anti nadeviations therefrom.Devlatiahs must first besuthr ertin vititev from the <br /> Building ONktfalhoforo bekt9ethhorit anydrotentrance,lam•the meeot,or1ten when t>ytae owner ofthis properly fo perform the work fcrtvtrtctr applicahtm h:made. <br /> ands whit the State Centex rttit.27Rav and 208.200AMC. <br /> City of Everett WWI am cory <br /> .. <br /> t ✓ U r to ( PERMIT tf <br /> dAvlbos na to Date Revised2/8/202r) <br /> IZ <br />