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E 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 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 Bleak Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET a`I )5 ' )1Tti t\- 6 - R PARCEL#: <br /> crrY fve1-Pa*)' STATE WA ZIP 9W)C.1 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): � c c b(N ) IL' <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: <br /> ' Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A L ,ts\�,, e.C OW,no c 1.1 C <br /> OWNER MAILING ADDRESS: sTREEr G 3 co 5 y(h e c. C lJc y <br /> / 5ke W3v <br /> CITY C e,- 4 .e n n',h 1 STATE <br /> C o ZIP <br /> OWNER PHONE: (OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: S 4�� W I,,I-e( <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): Sc t L✓ q3 a L. I 'CITY OF EVERETT BUSINESS LICENSE#REQUIRED nn <br /> ( : t�) eeeic,} �oZI <br /> CONTRACTOR ADDRESS: sTREEr (3 15 P66-3‘.,,,�4,„ St <br /> CITY A ) I`Jr ti STATE VA- ZIP aa3lL( <br /> CONTRACTOR PHONE: 703-t-f a,2 6 ti? 'CONTRACTOR EMAIL: C�,eico,n < e w A4O( C a✓vt <br /> PRIMARY CONTACT: ... ... ._.... .�_..:. ...:....._ .......,...... . .�. ,.... _ <br /> ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 7 <br /> 6 <br /> 3- 117 a- a61 41 <br /> i 6 rl c'‘2, 1SL'(4eftn CONTACT EMAIL: 6 Aei ye,c7 . " 1.V C,C opt <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ LIj /6-p 'ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair m rket value of all labor,materials,and equipment needed to complete the work,whether actually paid or not) <br /> EXISTING USE OF BUILDING: Aga r*pA e„ } <br /> PROPOSED USE OF BUILDING: )v6 CA,,‘,., Z <br /> HEAT SOURCE: ❑Gas )Electric .00ther <br /> BUILDING TYPE: OSFR OTownhouse ODuplex OADU NiMulti-Family-#Units: q ❑Commercial ClAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction DAddition ORemodel NRepair OT.I. OChange of Use <br /> OModular ❑Portable ['Re-roof ❑Exterior Alteration OTank(above ground) OAccessory Structure <br /> OFence over 7ft high ORackStorage OPool/Hot Tub ❑Tank(above ground) OOther: <br /> • <br /> DESCRIPTION OF WORK: <br /> L <br /> �26"t0Vln� y2�� 7jLe21-CoCI= iq aCce4 �kur--t'J~“.J`, QykCln.Th <br /> W t�'l1 �'i 1 / i_e�X <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.lam the owner,or I am authorized by the owner of this properly to perform the work for which application Is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT// <br /> N�( ,a /a/� ti 2 I I Z- 0 Z3 I <br /> 3wnerlAuthorized Agent Signature Date <br /> (Revised 2/8/2021) <br />