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mois BUILDING PERMIT APPLICAT• <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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET j5g0 eE/14, 'f IVe-j//6W DI'ARCEL#: g2 D g <br /> CITY r--frEirEit- <br /> STATE W4S/1 ZIP 94E20 ( <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): --THE SficbRE 14 /f//t/f .s-re:ye/' a E <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> �-y- CONTACT INFORMATION <br /> OWNER NAME: /7ifiAJP M. r,,� <br /> OWNER MAILING ADDRESS: STREET !23 i t/ ER i4*1z r /� <br /> CITY &Y -R / ' [ STATE Pi /4/71 ZIP 9,>I0d�l <br /> OWNER PHONE: —.;e1.2$ OWNER EMAIL: �7Ef/f(/L (1- [v VAN e `-C/mil <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ,a OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACTT�NAME:f/� J� CONTACT PHONE:,(ZJ- 22.— + 92 g <br /> /1 / ` �� � CONTACT EMAIL: e,/W /4 L Y�#QC"�r 041 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 'f 04 QV 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: fl//V r 5T6l c'E <br /> PROPOSED USE OF BUILDING: S/Tl/4 <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other /I'I1/.0 <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 /> DESCRIPTION OF WORK: j��� /� <br /> Rein i v ruk_ C ff C Yes ®v �c p,p Rs <br /> et-firl/ ktr)b°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 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 /> dLrn . <br /> City of Everett Official Use Only g-+a.4 Z PERMIT2 o <br /> Owner/Authorized Agen ignature Date (Revised 2/8/2021) <br /> 1/� <br />