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•ILDING PERMIT APPLICAION <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 2.001 Caar (� - PARCEL#: DO 563/OI Qua/OQ <br /> CITY ENRA STATE Wpt ZIP IVZO <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:QF�dldl"K 0+o'D-6O Lot No.: .� (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1lG 0 1 gOYY <br /> OWNER MAILING ADDRESS: STREET ZOQA' Ceo.ar <br /> are STATE tAP. ZIP 8-201 <br /> OWNER PHONE: (' 2 20-1-0 Co 3 _OWNER EMAIL: n(rjol, zoxr c -O c i I-c�n� <br /> CONTRACTOR COMPANY NAME: Ciur-Im G5 Co vi ru c,.7 i ovu vt G <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): (;o, C u�1C�9, �A #(CITY OF EVERETT BUSINESS LICENSE REQUIRE ): 039653 <br /> CONTRACTOR ADDRESS: STREET g,36 , f1 r Ave <br /> CITY La ` -v,.1 STATE WA ZIP r v r 68 <br /> CONTRACTOR PHONE: ( 26)23' 9 LiI CONTRACTOR EMAIL: CA) <br /> r/+5Cr645s cov, <br /> PRIMARY CONTACT: ItkOWNER rTONTRACTOR OTHER(Please Specify)ertAk.O•(65 otaA jt*4P� _ CO/ <br /> CONTACT NAME: CONTACT PHONE: (Lizb) z 'o- 3 1 <br /> CONTACT EMAIL: l'to ;C.17 • / 4j <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: /(0CLC_- SF�PROPOSED USE OF BUILDING: 14(4, " QyL +0 ex 1vij 14,0LA,Cpe, <br /> HEAT SOURCE: .as ,lectric )ther <br /> BUILDING TYPE: FR Illownhouse 1111,uplex ,DU lulti-Family-#Units: :ommercial ,ccessory Structure <br /> TYPE OF PROJECT(check all that apply): lew Construction r ,ddition emodel repair 11.1. ;hange of Use <br /> lodular [}ortable rTe-roof rTxterior Alteration ank(above ground) [---,ccessory Structure <br /> ence over 7ft high ;ackStorage 'ool/Hot Tub 'ank(above ground) )ther: <br /> DESCRIPTION OF WORK: <br /> Ad of i-i ck ex i5kivt I10A&L <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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 14.4eAr - 271- 6..2/ �, � iD 6- Of, , <br /> 0 n r/Authoriz-• ge '* ature Date (Revised 2/8/2021) l <br /> r �7 <br />