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E BU111 <br /> LDING PERMIT APPLICATI O <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 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 :c*-'63I iel6rreki l* PARCEL nc tz)e ,c,, -? > <br /> CITY alP,''€ STATE wJ yn t-- ZIP q(c22,t8SUITE/UNIT# .: FLOOR#: , ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <j`� GL, M � �.L-C <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: SA)rtjy 1-1/f..E.•5 Lot No.: , —7 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6e,r),- T f <br /> OWNER MAILING ADDRESSP STREET 1 ?VI q ,f,(0ra Ave <br /> CITY 5'korelQ STATE kikr ZIP gg-(33 <br /> OWNER PHONE: t4-711 r.44 i7 OWNER EMAIL: /orb."DS,a) ® cried/Rea>Lllc„� <br /> CONTRACTOR COMPANY NAME: -1a, J <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): r) M El ASSgS1Ng CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): rew {-` L7_ <br /> CONTRACTOR ADDRESS: STREET 1 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> OTHER(Please... _. <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR Specify) �.F�(C 3 F.,�_ <br /> CON CT NAME:'/(+sy>�LAA2._ ' , � !>✓ }�,. CONTACT PHONE: ' 6 ' L z 0,395 <br /> ( CONTACT EMAIL: I' ,I r `plc l cb I&)C Lv c-yV\- <br /> c <br /> BU1L NG INFORMATION <br /> VALUATION OF WOR $ V 20,, ©f 0, '� A SOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prey 'in fair market value of all labor,materials,and equip ent needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: ❑Gas ElElectric ❑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 ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIP ON OF WORK: <br /> Tv IAZ1 "fie- p(brl£j t; o a 414 f'(PC sit y 44 14olecde/r `l *.(1t <br /> us-RA G5D v area rfx 44 PacFss A/C PG' q faZ(, C S <br /> e + c Ogg- _ J <br /> ACKNOWLEDGEMENT*I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must omply 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 w ting from the <br /> Building Official b''.re b.'ng 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 h the Ste-Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> PERMIT#f720�'D <br /> � 1 <br /> S'/z3� `7��� r <br /> (., uwC r/Aut orized Agent Signature Date (Revised 2/8/2021) <br /> 113 <br />