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BUILDING PERMIT APPLICATION <br />EVERETTSUBMITTAL <br />CITY OF EVERETT PERMIT SERVICES <br />INSTRUCTIONS: See ePollwbb submittal onedllst per submllYl repulremenb and number M copes required for review, <br />WxeeINGTON <br />than drop of completetl aVeHerlon plus all required submittal documents b 3200 Cedar Street 2nd Floor Intake Umpe Box. <br />CONTACT IN FORMATION: (P)<25.25T.88101(E)evereBeps®everellwa.pov I(W) ovarelM'a.pwlpwmlls <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: may Z003 kJETNrCRG A-VE. PARCELW <br />cnr STATE WR 9194701 <br />-CA <br />SUITEMNIT#: FLOOR#: > ADDITIONAL LOCATION INFORMATION(if apPireEle):ID <br />TENANTIBUSINESS NAME pf Van residential): <br />LEGAL DESCRIPTION bnwrcoMwclbn: SMrI%aIM1UMIWaM: Who.: (slash mpyollmB Intel dwalon) <br />CONTACT INFORMATION <br />OWNERNAME: XoOmes QI;Lr41 <br />OWNER MAILING ADDRESS: STREET I0Y07 2ted avol, <br />nor, rzvee)t44� Was 1A)h ZIPe- <br />1� 1 <br />OWNERPHONE: -3 6- ypb OWNEREMNL: p froc.e Ae. Ae• <br />CONTRACTOR COMPANY NAME: _ <br />A STATE CONTRACTOR LICEMSEtly1EOUIRID OF EVERETT BDMNEBS LICEXBE#IREOUIRMI: <br />CONTRACTOR ADDRESS: MEET 77R7& Dr <br />w1rr E v <br />CONTRACTORPHONE: <br />COWRACTOREMML: //r— <br />PMMARYCOWACT: DOWNER XWNTRBICTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: COWACTPHONE: y <br />CONTACTEMAIL: IAi- <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 400in) IMBRICATED LAND USE PROJECTY H appiwble): <br />pry y bmip <br />EXISTING USE OF BUILDING:# D <br />PROPOSED USE OF BUILDING: <br />HEATSOURCE: ElGat >*acMc DORU <br />BUILDING TYPE: QSFR ElTownhcuse >lupiex ❑ADU E]MuIU-Famly -k Units:_ OCommerelal ON' spy SpltlVe <br />TYPE OF PROJECT IcheckallfkINapplY): LIN"Construclion DAddillon >kRomOJel aitHIRepair E3T.I. 13CkangsoTUee <br />01sloduier ElPorable ORamof OFxledw AllemBcn OTenk(ehoveground) DAcmasory SlmcluM <br />OFenuover TNhigh EIRock5lerage E1Pos*Hct Tub Elfank(Moaeground) ODther. <br />DESCRIPTION OF WORK: <br />—OQLJfAJRL_[_ - RENMiE bAS NeATM CON .vIECrF <br />—ReMoval of flwn��g �PtaMl <br />—�hS7Ml� smote Vetee�ors <br />ACROOKEnGEMENT, I hove rewewaamkapp kaaananom+PomIM MNmeiMn cm se adeween is how algwnn. ahM1amegoaNentro INspmYi muslwnrpy don <br />waam 2darat akre, eMdfel redo. rnee�map orepaaManyaWmaroe aPAmwa NwxemnoaaWerw..memaxa. GaWerdN.manaal neea;aamaro un;,pnm,Ine <br />adMp Gnkbreeelntapnonma unee.enreWumfrdwe.lemlm wme., wlemeMlwluanr lln a»iverlMe pgvM/ru Maa^^Ike worx lw Man epptldMdmNe, <br />aWlaamply Won (he <br />me sere comrearwe law lazvrscwammazopa wne <br />(Ylyol Evxelr 011kbl Use Om'y <br />PERMIT# 1322I0—�`L <br />OxnarlAmhodwd easel Signature Dee lRavkea PMlazi) <br />