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IE.. • • <br /> BM BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E ,� <br /> 5°„iFSMIT:'AL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review <br /> WASKINGTON then drop off cornpieted application plus ail required submittal documents to 3200 Ceuar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps aieverettwa.gcv I(W)everettwa.govloermits <br /> (Blue or Black , t•roIy'Pkasp) „$ ,PBOJE T t`E:INS:ORMATI I+I , <br /> PROJEC':'S;TE ADDRESS: STREE 11014' 1(1 -h Ave, St t # 18A PARCEL#: .4 <br /> _....___ cIr srATi <br /> TE (/UA Z1"_zLi - _ <br /> JU'r SULTE' # _ FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS 11.AM :(if non-residential): L01111 L001i SPA � _ .:, <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal de;crip::,:r <br /> r <br /> y�r►►./qy'f ��u1 ��yy�r/�ggyygY� /a raw , ,s.+��maa-'- =-ar- <br /> a , ':coNTA:lorl tioc tie T! , u <br /> NYt<_.yuyata ) -�L'.aYYa1LYs.� .�rZ•IJF <br /> OWNEk.NtLGHE: CO AtL S>?rti <br /> OWNEl_NIA LIN3 ALDRESS: STREET pb go-A ix/3 .—.- .J <br /> ....�� CIT"._____y�"k — STATE SLY --�..�..e.Z' /'i i o/ <br /> OWNEr N li IN E: OWNER EMAIL: <br /> CONTlA )R COMPANY NAME: U g \ (.45,aSt1l u.-toy, 1.NG. _...� <br /> WA ST a i E CONTRACTOR OR LICENSE#(REQUIRED): C� GI1 �2 ?A/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONT(. CTOR ADDRESS: STREET 27/OD )2).S± P L , <br /> ,�,n i <br /> CITY IC elef- STATE Lt/ _' 0 <br /> oi <br /> CONTACTOR PHONE: 15— CoTRACTr31<EMAIL: OHUA Z 6 a Conf._= :�. <br /> �IT .4� v <br /> PRIMAR`:`CONTACT: 0 OWNER Z.CONTRACTOR ❑OTHER(Please S ' <br /> .W W Specify) <br /> W.a..._. _ <br /> CONT,=+ �T NAME: CONTACT PHONE: 6 715—P I07 <br /> CONTACT EMAIL: <br /> `(u ouq 2. � <br /> Jce.�Yr>oWIIRt. .., .. a .._. .. .,, s�-fas► 4a.-3 <br /> !, BUILDING INI=ORMA, ON _., - <br /> VAL.UP-ISll C F INOR : $ cO0 ASSOCIATED LAND USE PROJECT It (if applicable): <br /> (valuate. r I ciude the p evading'air market value of at labor.metenais,and equipment needed to complete the wc•rk,whether actually paid cr not.) <br /> 1 <br /> EXISTS .:i U ir.OF EUlLDING° <br /> PFt JPi : EC)USE OF BUILDING: <br /> HEAT.,OURCL: 543es ElElectric ❑Other --� ---11 <br /> BUILDING'I (i'E: ❑SFR ❑Townhouse ❑Duplex C1AD`J DMu ti-Fam;ly-#Units: I. <br /> KCommeroia's DA:essory Structure <br /> - <br /> T`r'PE :iP PROJECT(check a) that apply): ❑New Construction ❑Addition ❑Remodel DRepair XT.I. DCharge of Use <br /> 0 <br /> r_aNAc:;..dar DPorti b;a ❑Re-roof El Exterior Alteration ❑Tank(above ground) DAccessory Structure <br /> C Fec-:::ove 1't high DRackStorage C)Pool/Hot Tub OTank(above ground) DOther: t <br /> DESClt'isIIC3f,OF111,'J K: <br /> 1:efl all't 7_,,ippeAe4 for 6 ass r►ms aJ I -Taw, cka e- ►am . <br /> c� <br /> i <br /> I <br /> ACr:iVO!"`..•F'`C;F v.'ENT;,hs;a reviewed this application and confirm the information contained herein is true and correct Work done pursuant to Ibis pe'mlt must comply with <br /> currant,:.ra-, state• and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorzeo'in wriiing from the <br /> 8u'f'rling:,f.cia.before being aathorizaa under any circumstance.I am the owner,or I err authorized by the or.ner of this property to perform the work no whict.eppilcati 7,1 is'oiede, <br /> end i co'- i/ty.r.•the State Contractors Law 78.27 RCW and 295.200A WAG. <br /> City of Everett Ofcfv Use Only <br /> PERMIT# .....,��.� <br /> Owner/l:I:th.ot laud Agent Signature Date (Revised 2/8,2021) <br /> I <br /> Z <br />