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• • <br /> nomm <br /> BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES • <br /> EVERETTSUBMITTAL 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 42 C? 1 .(E ��k 1i.1 t74-\ PARCEL#: <br /> Le_c ( STATE V,..) ZIP C{82.0 <br /> SUITE/UNIT#: ()nit f n('O Li FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):li <br /> TENANT/BUSINESS NAME(if non-residential): 0`\,j Q\( V\e tA,\y � 'kW fx.4(fJI�.\L " T> C__n 1 t Pc <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N in Lot No.: N1 A (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: CJ1AM raun K(jV74c q <br /> OWNER MAILING ADDRESS: STREET J�S 1 '�L �� iv` Are IQ E. <br /> CITY e l t]E. y l (1 STATE j' ZIP 4�306 LI <br /> OWNER PHONE: `12 1 1 1 1 .i 1 'O IIIWNER EMAIL: C G mum v_OC.N,)'( ' VIVO <br /> I � � <br /> CONTRACTOR COMPANY NAME: -P1.0 :C>0 S TOM U ILp GiR_S «r(,. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED). .At E c. <br /> fj /lS I� �S�(D�CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �EL.C-I Pr <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE \/i. - ZIP 1 g v y <br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: 12 OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT, NAME: y1� CONTACT PHONE: t.I2-c 7 (Do , <br /> 1 i 10v"� 1 t �J i07 CONTACT EMAIL: (G,irn k OC:;^c7 r C cit \ C cyd`' <br /> ( BUILDING INFORMATION <br /> VALUATION OF WORK:$ 5 Z St 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: O 1 I L Le) ) J A t. <br /> PROPOSED USE OF BUILDING: ( h 'k C IZ C <br /> HEAT SOURCE: L76s QgIectric 0 Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 6Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair . ❑Change of Use <br /> ❑Modular ❑Portable ORe-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 /> Nt)Tc ' I<xl )fitx /Iv( a� i lh �� �l�ry�h���'► <br /> (tot i (t4! dart Se()A1-6"7 <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 /> ti,tti•,�\ PERMIT# <br /> I� 1 13 2) 31 - 0 3 <br /> Owner/Aut orized Agent Signature Date (Revised 2/8/2021) �� <br />