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imm <br /> BUILDING PERMIT APPLICATIUN <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 51/ £ B>✓ec Iij cy. PARCEL#: TgJ jtJite i S`(,w3 Y4id i5 f1/Yr/ <br /> CITY �v�,I, (✓* STATE V Vr- ZIP (�z0 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): / <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: 6a{j f 55 ge,e(�( Lot No.: 7. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /VI i its ( 601 6 "1/1 <br /> OWNER MAILING ADDRESS: STREET Po ?Co'( /) <br /> 2_211.5- <br /> CITY r, (4-y'� STATE i,J/j ZIP -/Q(�v 8 , <br /> OWNER PHONE: OWNER EMAIL: {{{ <br /> CONTRACTOR COMPANY NAME: (jAPpic/ji <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): Fy��K $5��5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3 7e <br /> CONTRACTOR ADDRESS: STREET )100 $p)C ..211/ <br /> CITY g_I I let STATETATE wif ZIP ff 0,;�3 <br /> CONTRACTOR PHONE: )427'q11� C. CONTRACTOR EMAIL: i`-r ""eef i/4e l'- -meet i <br /> PRIMARY CONTACT: ElOWNER U"CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: GfzS— <br /> f�) /'11T CONTACT EMAIL: P e /h 1, <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 6?) Ol) 3Gs ASSOCIATED LAND USE PROJECT#(if applicable): ge-vi2I'—o5.f <br /> (Valuation shall include the prevailin r mafket value of all labor,rr. teria s,a quipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: 6f 1 -- <br /> HEAT SOURCE: ❑Gas IJtlectric ❑Other <br /> L_1✓S BUILDING TYPE: FGa/R ❑Townhouse EDuplex,,-.,, EADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): WtNeup/w 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: <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 wit a ate C tractors 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /ozo/Z/ 21\0 — OLf% <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />