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BUILDING PERMIT APPLICATI!N <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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 38'///, /'))�//TM 4VJE PARCEL#: 51.1)6- A <br /> CITY A-1/6(VjJ ET/ STATE W4s/J ZIP 9a2 / <br /> SUITE/UNIT#: FLOOR#: ! ADDITIONAL LOCATION INFORMATION, � (if applicable):/� <br /> TENANT/BUSINESS NAME(if non-residential): THE S O4 EM(uSE 1/ /1 I -57 R rT 6T 6_ <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> r � CONTACT INFORMATION <br /> OWNER NAME: PN/L// /`( r £5725 P <br /> OWNER MAILING ADDRESS: STREET /e?-5( <br /> CITY E ' 1E7 STATE f SN ZIP 9ge....eot <br /> OWNER PHONE: S'"'?1 5 2,'- 4(9 2.8 OWNER EMAIL: , `sTE>/ /A/f VAJ-fd', c O *( <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: �t CONTACT PHONE: Ta j— j.Z--- 4/9 ?8P/1/ e /f Me �--sTEf CONTACT EMAIL <br /> s repieW I tip& 400, eon <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ C93(4 ' ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair markets/valuelu of,all a/labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: /i7//%'7 -57.4n1RA 674— <br /> PROPOSED USE OF BUILDING: R/'�!E <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other A/Q is <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: /9 $Commercial ElAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.l. ❑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 /> RED+ ®r/.0 R 'Jo 1"9 <br /> g, 4oVE ,I.k. . OFTs n-/yb 44 D13 EigS <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 /> 447,4,41 <br /> Owner/Authorized Agent ignature Date (Revised 2/8/2021) <br />