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• <br /> �ILDING PERMIT AP�■. PLICATfON <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 Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET i Cif �' t PARCEL#: ,2s Pa 0 — d c' J- ,/iy <br /> i� trz �t-C i/" �j""A, �v`Q.��.41 �-�I'/ Qa� lv/ STATE WIT Z P 9U aG <br /> SUITE/UNIT#: ✓ FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable): <br /> TENANT/BUSINESS NAME(If non-residential): A m (KlL. tg v-cn,v <br /> LEGAL DESCRIPTION for new construction: Short PlaUsubdivision: A49- Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: g D r k"kit_ JAIck <br /> OWNER MAILING ADDRESS: STREET / 3 C g u/ k 0 $ WAY <br /> CnY V-C.ii—CA7t. STATE 1,41ht ZIP 'rf-20 Y <br /> OWNER PHONE: Yo, 5- 3 OWNER EMAIL: f� �Cn ��, (5 rj)9:l'L, Co -' <br /> CONTRACTOR COMPANY NAME: 04 — O wilt-e-jes w1.j/ le,,;/d <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE <br /> ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: tiroWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ A} O a v ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shal include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actualy paid or not) <br /> EXISTING USE OF BUILDING: 'r y-v-'r-..✓ <br /> PROPOSED USE OF BUILDING: ,5Q-/eaAi <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 ORe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑PooUHot Tub ❑Tank(above ground) Other. r�c h .c..htd g thl- c44oi <br /> DESCRIPTION OF WORK: t /o 5 1,4 <br /> ,-4.o <br /> I ed �, p /a..44, EA/c_%s AA. r <br /> �— srp //4 0-rn4 1 Cie rc.c;phi✓ '# me-rev c./ems�►,c� <br /> 3 — ,teV1yfrV LQ esio r✓i— /eCIJiw,✓ wiMt air" R9A) ) iZr""�C' je��a viSow <br /> k)041 M50 15 Win lam. iv)arwe nue..1- 6jv Sd.-e.- <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is live and conect.Work done pursuant to this permit must comply with <br /> current federal,slate,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 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 w 18.27 RCW and 296.200A WAC. <br /> ( f' City of Everett Midi Use Only <br /> S PERMIT# <br /> is(,�( ��o 7 gz� a6 —�t-Z <br /> Ownethortz�ed'A (/) <br /> 'Agent Signature Datet � (Revised 2/8!2 2 0 1) ''— <br />