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BDING PERMIT APPLICATI <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[(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET Q®2-- AI /3ALo/1-cL4,4?-y PARCEL#: dZ 5..`7 0,1,0 110 D <br /> CITY j1/61 5- . STATE I4 ZIP 945,2.0 <br /> SUITE/UNIT#: J' FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): C C/ 0/$ /,O,fi e Ly/ /Ala 64 rm t,i� /D2'�4'`�l ( L e <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: - - Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ;roil_e,„/n ti li)e L t o`t"ci V--tetr‘60 <br /> l� v <br /> OWNER MAILING ADDRESS: STREET ' 19 I pe.d/I,v L P t/C <br /> CITY IIµE/' STATE 14,4- ZIP LQJ,-.o <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: T 9 L. rp 61(.4g ( <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 377 "! <br /> CONTRACTOR ADDRESS: STREET l vZ tip/ '/-�✓/ �y (�,Gr <br /> CITY go C1.B414— STATE LIJ2 ZIP -.O y <br /> CONTRACTOR PHONE: 60,5*--l/a (a 1412 CONTRACTOR EMAILP/t/fro P/h h cosy ce ' t ' c 6,04-7 <br /> PRIMARY CONTACT: ❑OWNER L CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2._a 6 - q l o g <br /> 1261 ,t. 7sv ,1��, CONTACT EMAIL: `sy jia / � s vy�/LL��t 60,0-7 <br /> 7 BUILDING INFORMATION <br /> VALUATION OF WORK:$ jam/ O A o , b� ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair mark&t value of all labor,materials,and equipment needed to complete the work,whether actually paid Or not.) <br /> -Ad <br /> EXISTING USE OF BUILDING: CoPROPOSED USE OF BUILDING: C_ I��C d A o <br /> HEAT SOURCE: [l as ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 467mmercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition PlCmodel Repair ❑T.I. �hange 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 /> New tv tt s t erg 04 'cam,z 1,4- " pia <br /> �.�`�/ Y <br /> L�vr� 1' q / 1-1 Le- <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.1 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 Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 10- 13 - 2-1 Tkg k 2� 01GI <br /> Ow er/A on91Ageigignature Date (Revised 2/8/2021) <br />