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_ • • <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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION // <br /> PROJECT SITE ADDRESS: STREET 2 8/7 1/1/0T�ro� ,'(/e PARCEL#: ao�(5/06`p� QGy/DO <br /> CITY EgerGGSTATE INi " ZIP r8 Za / <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): {/V1/fi Me)AT�? <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: rNNE-ze�� 43Lsk' Lot No.:���ga h copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6 9 K/P <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: 5itan e( dweilm7( . coW' <br /> CONTRACTOR COMPANY NAME: rep <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 "4I OTHER(Please Specify) ,,'4/7//7- <br /> CONTACT NAME: Dq#i e//C ,owlet" CONTACT PHONE: <br /> 2 a✓GAr 7 ✓'{ CONTACT EMAIL:fi j��e ZSaG1✓GLIi4—G ✓�. fir✓+ <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 6 ;d d p a ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair marketralue of all labor.materials.and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: A(00/ .7 <br /> PROPOSED USE OF BUILDING: gt-t4i4-tG55' <br /> HEAT SOURCE: ❑Gas Electric ❑Other <br /> BUILDING TYPE: ❑SFR Townhouse El Duplex ❑ADU ❑Multi-Family-#Units: )Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair , T.l. ❑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: <br /> DESCRIPTION OF WORK: <br /> �n o77'-.e T/. of aH Pxc5-74' *600 5: - 0 ic2 <br /> g/7zer'or74'd 4c tom/ 3 - 20/B <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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> // PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> 1) <br />