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121 BUSING PERMIT APPLICATIO <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 1(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 8407 18TH AVE W APT 11 103 PARCEL#: 00705401110300 <br /> cmr EVERETT STATE WA ZIP 98204 <br /> SUITE/UNIT#: 11 103 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:SAMATHA KRAWCZYK <br /> OWNER MAILING ADDRESS: STREET 8408 18TH AVE W APT 11 103 <br /> cmr, EVERETT STATE WA ZIP 98204 <br /> OWNER PHONE:425-633-7763 OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: THE HOME DEPOT <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):HOMED**088RH CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET PO BOX 105451 <br /> crrr ATLANTA STATE GA zip 30348 <br /> CONTRACTOR PHONE:360-945-2787 CONTRACTOR EMAIL:NAIDA@NWPERMIT.COM <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) CONTRACTOR'S AGENT <br /> CONTACT NAME: CONTACT PHONE: 604-314-4569 <br /> NAIDA KHAN/NORTHWEST PERMIT INC. CONTACT EMAIL:NAIDA@NWPERMIT.COM <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$10598.42 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: MULTIFAM <br /> PROPOSED USE OF BUILDING: MULTIFAM <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <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 ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:REPLACE 5 WINDOWS AND 1 SLIDING PATIO DOOR IN EXISTING MULTIFAM. <br /> UNIT. NO SIZE/STRUCTURAL CHANGES. <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 WAG. <br /> City of Everett Official Use Only <br /> PERMIT#/VGr � K� 11/1/2021 T D` I I <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) 1 <br />