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i <br /> S.. BUILDING • <br /> 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/I <br /> PROJECT SITE ADDRESS: STREET j 1, j, I Tff A-1�E, PARCEL#: 8417 6 /,,p <br /> 9 <br /> STATE J4 �Jf ZIP 9 Z,f, <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if <br /> 7 <br /> (if applicable): ®n <br /> TENANT/BUSINESS NAME(if non-residential): 7//1E .STai E-NCR S`E //lN/ -S b/\ 11. E. <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> / CONTACT INFORMATION <br /> OWNER NAME: P/ //�y lP , E.S rep <br /> OWNER MAILING ADDRESS: STREET r/ale/ itie k' <br /> CITY 4/E7 STATE i/�X/Y ZIP 2182 <br /> d <br /> OWNER PHONE: '4.7_,"-.Z�.� 7"9.z'3 OWNER EMAIL: .sTEf'PH `,,if c W I I , <br /> CONTRACTOR COMPANY NAME: <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: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: j� y� T CONTACT PHONE: LyJ /2j � -- Z19�. <br /> J / to(�'_" f N'4 t ES / EE CONTACT EMAIL: is( C--pl-f(ff,f p& T A/ boo.. C0 ppt <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ j,,One), °- 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: /N�I Sc/ ORA E <br /> PROPOSED USE OF BUILDING: S t 4 �,,/ <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other Ale) V E <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <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 flank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> HEM D i/E Al£ C i-Ek VVs 0 V E g /a► II' <br /> RE V.E -J.,tk LOFTS 4 A 13 LA €fps <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 <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 /> 2? (rCity of Everett Official Use Only <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />