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B•DING PERMIT APPLICATION <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)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET!O/a giELzajA / PARCEL#: <br /> CITY (/i/2_ 7T STATE GJA ZIP / ©/ <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): A �---- <br /> TENANT/BUSINESS NAME(if non-residential): //n +�Q �r - : /tEE Lf <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: — Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /G'A dj�e <br /> OWNER MAILING ADDRESS: STREET '-J `78 rf�I jC•�„ <br /> CITY ".-Tfa4,1 W(®,11 STATE ./A.J 4 n '/ zip 9g) 7 L <br /> OWNER PHONE: 4,2c20— 98g q OWNER EMAIL6S/4-A'e 50NT1StTCAAC��`! <br /> CONTRACTOR COMPANY NAME:-QR cs ELT (c Q Not kT(24, W% I 0 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): / I�4, ,/ERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: sTREET/, %/0 8 7 &. 5r J C " ,�"-- ( LJ, <br /> CITY,kE• 3 1L STATE Z�/`�- zip 9 s e <br /> CONTRACTOR PHONE:q 2c-,5-/_3 (Cf CONTRACTOR EMAIL: pk(7,.37` 7-,c 5eV"C 4 L, , <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 6./2At aL/E6 CONTACT PHONE: %OLS `-7g-y—3/ / <br /> CONTACT EMAIL: P2G erg VC AOLC ( <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 17 , crn b 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: GL <br /> PROPOSED USE OF BUILDING: Qr �j/G i�I tYL=L el t3 f rl L J e _I 6.1 ?i y7L/77-67 <br /> HEAT SOURCE: ❑Gas Mlectric DOther /�AND ® � <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ` f'.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 /> DESCRIPTION OF WORK: / /f d1 RJ /��e/ OF £0'-1 /Ainz e/ A/ON_ .4 <br /> / LL Av /�Y RE e lik(�T-- �7' 1 r <br /> e FR e ffi-.'a ,4 c 77 Vi7L-/ Aluyist, C'CA/7-- eJ e/c <br /> DeR.-I u'ram AIY0 McP-/„w <br /> ACKNOWLEDGEMENT:I have reviewed this application and confine 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 1 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 /> O er/Authorized Agent ' nature Date (Revised 4/21/2022) {� <br />