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40 • <br /> am <br /> Li 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 al required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810((E)everettepsOeverettwa.gov I(W)everettwa.gov/permila <br /> !(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET k$I ���� PARCEL#:�"1owl(�..'" t$m <br /> V�+' <br /> STATE s Zip 94; <br /> SUITE/UNIT#: tAVL, 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 c r&'ply Ory y <br /> OWNER MAILING ADDRESS' STREET 1. 1 <br /> Vqm��{�` ,�FF 1l�� r/J� <br /> V STATE V h ZiP L• <br /> OWNER PHONE .0111) %01 - EAPIti <br /> OWNER EMAIL; il'( yy *f2 ><tiY°�4vn".0 <br /> CONTRACTOR COMPANY NAME: s "t <br /> •WA STATE CONTRACTOR LICENSE#(REQUIRED): ( , w4)-1 ...c CITY OF EVERETT BUSINESS LICENSE#(REQQUIRED): GI l ' <br /> CONTRACTOR ADDRESS: aTREEr f'n'�,, 4:71.A\1 ° yI t w <br /> CONTRACTOR PHONE; Q )3'' CONTRACTOR EMAIL NAiArlrtiej Utsycli <br /> ,, <br /> PRIMARY CONTACT: ❑OWNER 14 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> p� CONTACT PHONE.(St ' <br /> 211,6 <br /> ti11$ Wv !,kJCONTACT EMAIL: <br /> Rn>nk axis �� <br /> BUILDING_INFORMATION <br /> VALUATION OF WORK:$ 4� Ob. ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (VaivaBon ehatltrtr,ltrde the pravatling�ma�rket value of all labor,materials,and equ pment needed to complete the work whether actually paid ornol 1 - <br /> EXISTING USE OF BUILDING:" <br /> PROPOSED USE OF BUILDING; to40 lO1W <br /> HEAT SOURCE: OGas KElectric DOther • <br /> BUILDING TYPE: ❑SFR ❑Townhouse ODupiex CJADU Muttl-Family #Units:16.5 ❑Commercial ❑Accessory Struclure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T,I. ❑Change of Use <br /> ❑Modular ❑Portable Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> g ground)❑Fence over 7ft high ❑RackStora a ❑Pool/Hot Tub ❑Tank(above round ❑Other: <br /> DESCRIPTION OF WORK <br /> Viormtva\ 6t,\214;01,9wkvol. 0. N \ar .goop. , <br /> ., <br /> , .. ..., <br /> ACKNOWLEDGEMENT:I have rev(ewe�mnoa application end <br /> confirm <br /> oy f rm the information approved contaIned <br /> and herein do is true and <br /> therefrom. Work <br /> don •h i <br /> a pursuant to this permit must comply with <br /> current federal,state,end local law.Themust first be authorized in willing from the i, <br /> Building Official before being authorized under any circumstance.I am the owner,or1 em authorized by the ownerel lark property to perform the work for which appiloetlon is made, <br /> and i comply with the State Co:, clors Law 18.27 RCW and 298.200A WAC. <br /> ClfyofEverett Official Use Only <br /> PERMIT# . <br /> Owner/Author- •d s:nt;,, Date '(Revised 2/8/2020 .,I <br />