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• <br /> BUILDING 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 <br /> PROJECT SITE ADDRESS: STREET Yid" ,944lT'/ 4IiEr PARCEL#: 14Dg �7 <br /> CITY .EVER STATE W4S// ZIP 9 Q.+ o <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): T/z� ��/� //O1.L,.;', /AO �Tp,' GE <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Pill // 44, �7E/ <br /> OWNER MAILING ADDRESS: STREET / 3/ /QLC e- ,-t'E <br /> CITY STATE Witg,�i{ ZIP 9 zc <br /> OWNER PHONE: j E OWNER EMAIL: T ioJ'r//J f/ Q V4HOo, ti/%( <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: �rJ�J CONTACT PHONE: �2�--„��.5rJ ,;� - �(9 jd�$`'1� <br /> FM in //t / E CONTACT EMAIL:. STr/'P /1IP mhtee;, rof <br /> BUIL NG INFORMATION <br /> VALUATION OF WOR : $ 3 no, SOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prey 'ling fair market valuey of all labor,materials,and e pmentneeded to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILD! : f i'/l 4O ,4I1 E' <br /> PROPOSED USE OF BUILDING: - /49-i <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other A/C9 / Y <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ECommercial ❑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 ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> RE m1 VE AAA ENE&,...s. © ts ,g 3'/o",rQN <br /> ern4 VIE 4-Aij 0f j'S 4-A40 2 AA.IJ,e S <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 /> City of Everett Official Use Only <br /> * PE'`T# <br /> ,rAtit <br /> Owner/Authorized Agent nature Date (Revised 2/8/2021) <br /> '1z <br />