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ALONG PERMIT APPL1C•Uly <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:241746TREET d i,[•�scj .jv •S PARCEL#: 4/4 'LZ&viceT CITY L� STATE S W ' ZIP <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME (if non-residential): °C59r/ <br /> LEGAL DESCRIPTION for new construction: Short PlaUssubd isioon: phi IotvlSlo►� k G Vol.5 of No.: (attach copy of long legal description) <br /> - <br /> CONTACT INFORMATION <br /> OWNER NAME: 11/4 pA-1.A ~ N'p OtA0S-r 1 <br /> OWNER MAILING ADDRESS: STREET 2_096 <br /> 0.,A- F-5 <br /> 'A- J€ Cj Q 2,6(CITY IA"fl STATE a ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: Q /7 N 1 J H&1,0 14- Coli s &h O v'l <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): NI 1 14 HI('L g 4`rM I' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (a LG 5 5 <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: `> <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR KOTHER(Please Specify) A Lt: -t./4► - �0121�T <br /> CONTACT NAME: CONTACT PHONE: 3�D , Ze/ O S o e <br /> A Mi-Arrope-- - £J L CONTACT EMAIL: 9 or in y vMG l AsleoatV)9 •60141 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ ?(0) 0O d 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: Gj I Ki I L� K 05 <br /> PROPOSED USE OF BUILDING: S t NGI L• e- .(L. cgs' <br /> HEAT SOURCE: 'Gas Electric ❑Other <br /> BUILDING TYPE: g.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: (.-�Q S , bo IT(oN vyD et-ova. j , i361) ds.A 4/6Prifi <br /> U 101,612.- f L lL A <br /> g. ro,/ ue lei w, <br /> — Ntw tot NtOo u S t? CA t W(i'4 te--O L41 .F:P. <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# z <br /> Ow TAuthQ ' Agent Signature Date (Revised 2/8/2021) <br /> rz <br />