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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 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 5505 Wetmore Ave PARCEL#: LT 2,BLK 5 LAUREL NIGHTS <br /> cm( Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Taylor Keim <br /> OWNER MAILING ADDRESS: STREET PO BOX 1597 <br /> CITY Mukilteo STATE WA ZIP 98275 <br /> OWNER PHONE:4257731693 � 1i.7 f� OWNER EMAIL: slightedgepainting@gmail.com <br /> E)W/-�CONTRACTOR COMPANY NAM ( (Jtl/n-- <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: IA OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: '/ CONTACT PHONE: 4 Z 5 — - 3 — iale I en" 6`3 <br /> CONTACT EMAIL: s 1;9I.,4---Q.��2P0.rn 1—i.� jw.gr I.Coin <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$$2500.00 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:Residential Home <br /> PROPOSED USE OF BUILDING:Residential Home <br /> HEAT SOURCE: ❑Gas Electric ❑Other <br /> BUILDING TYPE: 1SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition I RRemodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ElTank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> Adding a wall and closet in the downstairs open space to create a bedroom <br /> ACKNOWLEDGEMENT:1 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# <br /> 1��Z '�t gztio - 0 6 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> ) <br /> /' <br />