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4111 • <br /> irej BUILDING PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <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 ali required submittal documents to 3200 Cedar Street 2nd Floor intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everellwa.gov I(W)everettwa.govlpermlts <br /> -(Blue or Black Ink Only Please INFORMATION { <br /> `�B l Y ) PROJECT SITE <br /> PROJECT SITE ADDRESS: STREET �,(� 'ca tr 5 PARCEL II: <br /> ern' WOti STATE V V 0 Z112 <br /> SUITE/UNIT#: 146,, <br /> FLOOR 0: ADDITIONAL LOCATION INFORMATION(iFapptcable): <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 /> ji <br /> OWNER NAME:k !"6,1%-1 V CT))YYt <br /> OWNER MAILING ADDRESS: STREET O tI <br /> I' ` <br /> cm' v STATE�a 7fP ` 1 <br /> OWNER PHONE I➢ -�J OWNER EMAIL:T'O�tYn � fIcal cp. <br /> CONTRACTOR COMPANY NAME 1S cikY 01 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): �l1s�G4ii141_ CITY OF SVERETT BUSINESS LICENSE#(REQUIRED):51 l� <br /> CONTRACTOR ADDRESS: maw <br /> IV <br /> CONTRACTOR PHONE: <br /> �' �` CONTRACTOR EMAIL: (}t 'RI ' %net 1 , 1 Pt) <br /> PRIMARY CONTACT: ❑.OWNER ►;m CONTRACTOR Li OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE <br /> 6eAAt.Qr 0 t,9S CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ '1 } 6p 00 ASSOCIATED LAND USE PROJECT#-(If applicable): <br /> (Valuation shaglsoitide the prevelinsprma et value of all labor,materiels,and oqupment needed tocompiete the wont.whether;ochredlYpaid or not}' <br /> EXISTING USE E OF BUILDING: 011_ 0 <br /> PROPOSED USE OF BUILDING: 0340 ‘lorkes <br /> HEAT SOURCE: ❑Oas tittlectric Daher <br /> • <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU vluiti-Family-#Units 23 ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check aft that apply): ❑New Construction ❑Addlilon ❑Remodel ❑Repair OT.I. OChange of Use <br /> ❑Modular ❑Portable 131Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 71t high ❑RackStorage ❑Pool/Hot Tub OTank(above ground) ❑Other.„ li <br /> DESCRIPTION OF WORK: <br /> V <br /> 1 <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 0 <br /> Building Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, 0 <br /> end 1 comply with the State Contractors Lew 18.27 RCW and 298.200A WAC. <br /> Clly of Everett 011kisl Use Only <br /> PI"RNiIT it n <br /> Ownot/Auth. . Ag:n r ;_. re Dale {Revlsed2/8i2021j <br /> 1/2z. <br />