8015 BROADWAY CHICKA LATTE BEAUTIFUL COFFEE 2023-02-15

• • NM MI BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES E V E R E T T SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-88101(E)PermitServices@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 6U 1 _ , n � ��C PARCEL#: `S C�d 8 �3(2 -. :C) (✓CITY U 9�� STATE ZIP c-1XLr G SUITE/UNIT#: ], FLOOR#: I ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): r Ace 9 1 444 e_ ain-A A-" c L. Z C, LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N i fr Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: hp..--,--7\-ixA Ale."\-s,-)V\ . OWNER MAILING ADDRESS: STREET i LO Z,!Z., (3 Ci-1 t( eVe e--H /-1--vi ......... CITY �� lke l STATE �/ ZIP Ct I OWNER PHONE: 151'6- >1 LO- 2sft- i' OWNER EMAIL: De.'S I G/33 1fIAi-tci CONTRACTOR COMPANY NAME: AhIA-. � W0Ud. /—e1'4L - *- I�_ � • U. WA STATE CONTRACTOR LICENSE#(REQUIRED); 'V a CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N r1( (L1)U Q CONTRACTOR ADDRESS: STREET ) S 241 Cl Wiz_01 S52 L9 (Z ' 'S1- CITY cjQ© 1'" t 1 J'4\ STATE lA A ZIP Cra 21 61 r CONTRACTOR PHONE: q L _ `�I 7,-z Lf l CONTRACTOR EMAIL: AVJ PsakeS OCq4 c -, frL4- PRIMARY CONTACT: �,2QWNER El CONTRACTOR El OTHER(Please Specify) CONTACT NAME: / CONTACT PHONE: ' Si L Z / y:l�l CONTACT EMAIL: .��A 11/`)��-� t ,�L Cqq V\46 'T 1�t I L BUILDING INFORMATION VALUATION OF WORK:$ . 00 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labo`r,,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: � Ll�-1=�1` (`►� '�� ?(t c PROPOSED USE OF BUILDING: --� ��, HEAT SOURCE: CI Gas %Electric DOther BUILDING TYPE: ❑SFR DTownhouse ❑Duplex DADU DMulti-Family-#Units: Pkommercial DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction OAddition DRemodel ❑Repair DTI. ❑Change of Use ❑Modular ❑Portable DRe-roof ❑Exterior Alteration OTank(above ground) DAccessory 5 Structures n ❑ / Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub OTank(above ground) Other: .17� --VW-"A -. Ccf t i-Le DESCRIPTION OF WORK: - i 4-& -tA oFte `A -, :,.. pQ 6 cJ J-t- LA;:1'I'k C 1,-►eW 0, \a u�� .-1 , '11ke-A-6.3' a Co---/-(,C ,tfp pa-icAZ. ' G,>x iN t)tw ci ?it•:, i Use . Ooc i5 QC,. . . - Ut kc-11_ e' Aviabved 'poi uoy - of K Nt.th "-l:I t aw.cs_ p>Qi (1- +0 et,oc,e.ect . 2a 2Z'41 p zza (p oip 01-0A00 2 .-Dic-.-04/J tikAa4'N) 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Lisa Only /''' M ?OIL_ li• ZZOS--a Cp Owne Autho ed Agent Signature Date (Revised 4/21/2022) 2_