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_ • • <br /> 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 j(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: SIRES, 3 5L,> E1/44r<« I t s\ uz4,1 PARCEL#: as04 Zy bO tO t Sao <br /> cur' 6.1 Gc w A • ZIP 9 8 30'-{ <br /> SUITE/UNIT#: fy (pc FLOOR#: I� 1 tq ADDITIONAL LOCATION INFORMATION (if applicable): /4, ' A <br /> TENANT/BUSINESS NAME(if non-residential): 114c1 s\O o_ pt,yk ��, , SnG . <br /> LEGAL DESCRIPTION for new construction: Short Platisubdiv:s of I t/A t o. irk (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C_ ir V 'S'. 3uc+ice <br /> OWNER MAILING ADDRESS: STREET 34.13 Z.5 SA . �C <br /> CITY � ‘: STAfl W ZiP 98aa.3 <br /> OWNER PHONE: as. - 344- OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: F N P5Ire&' ce.0, 4-v,A-! 'L ,tic. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):F:elie Pc- 188 cry. CITY OF EVERETT BUSINESS LICENSE#(REOU1RED):3 s-g8 <br /> CONTRACTOR ADDRESS: STREET (4,:3°t,2'1 Z9 53- . PT� <br /> cm' L. At% ST6vee)$ S'.,-E LAM' zip 78 Z.5 8 <br /> CONTRACTOR PHONE: 915-33 0 2,Z93 CONTRACTOR EMAIL: Mc'wr►i G 12 F,1'S4-P1nasc .,i'( <br /> PRIMARY CONTACT: if OWNER :ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: /^�� L CONTACT PHONE: Z O 6 6 7 9 STL Z <br /> 'Teti 1 f`r'S�� CONTACT EMAIL: 'Troy ob3a( ..*tq'.4•0bday, coin^ <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:4.4-N-`�- ; 0 V- ASSOCIATED LAND USE PROJECT#(if applicable): Isi(A <br /> (Valuation snail include the prevailing fair market value of al labor. aterials,and equipment needed to complete the work.v.heiher actually paid or rot.) <br /> EXISTING USE OF BUILDING: CAWS:oh ��- <br /> PROPOSED USE OF BUILDING: CotiVl4\4 be.Qa�c(— <br /> HEAT SOURCE: JRZGas LlElectric ❑other <br /> BUILDING TYPE: L1SFR riTownhouse ❑Duplex ❑ADU LIMulti-Family-#Units: gCornmercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction LAddition ❑Remodel T 2epair ❑T.I. J'Change of Use <br /> LModular ❑Portable QRe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage (Pool/Hot Tub ❑Tank(above ground) theTCal l t.SS-L lc4 /t"i'i. <br /> lZsaO <br /> DESCRIPTION OF WORK: <br /> vet Cuc cen- - if�ct 1 loc�-�-�� - c� I C-�F'S a.41409-qK <br /> ACKNOWLEDGEMENT:!have reviewed this application and confirm the information contained heroin is true and correct.Work done pursuant to this permit must comply w. <br /> current federal,slate,and local law.The gran g.f a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before bein .uthonzed a ,er a, circumstance.f am the owner.or f am authorized by the owner of This property to perform the work for which application is made. <br /> and!comply with t - ' ate Con :cfors :w f'.27 RCW and 296 200A WAC. <br /> City of Everett Official Use Only <br /> ..�I, PERMIT n t t-1 <br /> Owner/Authorl ed Agent 'gn.•' ate (Revised 2/8/2021) <br /> �l� <br />