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40 <br /> • <br /> ILIIIItt BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements`and number of copies required for review, <br /> WASIONoroN then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION;(P)425 257.88101(E)everetteps®everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink OnlyPlease <br /> t� ) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS STREET 1% z `% PARCEL II• 001 O '2VL 40 tI <br /> CRY . aTATE.. ' F , <br /> SUITE/UNIT#:pi14,�j FLOOR#: ADDITIONAL LOCATION INFORMATION(If applicable): <br /> TENANTIBUSJNESS NAME(If non-residential); <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal desorlptlon) <br /> CONTACT INFORMATION <br /> OWNER NAME:. or n (' ',11)m <br /> OWNER MAILING ADDRESS: srnsEr ,9� <br /> til01' . <br /> OWNER PHONE Olt fLroi• % OWNER EMAIL: OYardY)t : U hQ oyn,rptittel <br /> CONTRACTOR COMPANY NAME:� , a'1 j <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): $if'; ,`,%$"'•)„ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Yj <br /> `CONTRACTOR ADDRESS: slnEET i <br /> CRY kAli STATELI\YA ZIP N h-f,S <br /> CONTRACTOR PHONE 6,10 1,051.j 'I CONTRACTOR EMAIL: n► ++rU(IS ro ea a t (;+per <br /> PRIMARY CONTACT: D OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: $110 <br /> k, <br /> tfi)rn U itt s CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ )7t\ b.tit) <br /> LAND USE PROJECT#(If applicable); <br /> dca II�� <br /> l(Va1uallon shall Include the prevailing felt nta t value of at tabor,maledale,and equ pment needed to complete the woik,whether actually pe or not) <br /> EXISTING USE OF BUILDING CAm1 A0 orgs <br /> PROPOSED USE OF BUILDING: ton Qo nlrtuts <br /> HEAT SOURCE: °Gas *lectrIc °Other i <br /> p y 1 <br /> BUILDING TYPE DSFR ❑Townhouse °Du lex DADU gMuifi-Family II Units: IDCommerciai CJAccessory Structure ' <br /> TYPE OF PROJECT(check all that apply): °New Construction ©Addition °Remodel ❑Repair OT.1. DChange of Use <br /> °Modular °Portable tl'ie-roof °Exterior Alteration °Tank(above ground) °Accessory Structure <br /> °Fence over 7ft high DRackStorage ❑Pool/Hot Tub ❑Tank(above ground) °Other: <br /> DESCRIP#Old OF WORN; <br /> \?eV11ev131 9Y10A i:490l9,.celr n1- t Vos rde Rom' <br /> f <br /> ACKNOWLEDGEMENT I have reviewed this application and conflnn the information contained herein Is lure and mama Work done pursuant to this permit must comply with <br /> current fedora!(state,end local law.The granting of a pemrit only authorizes approved work end no deviations therefrom.Deviations nwsl 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!hewer*for which application Is made, <br /> and I co h; a State actors Law f8.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> , <br /> PERMIT#tt <br /> Owner/Authorized Agen ure Date (Revised 2?8/2021) +' <br />