Laserfiche WebLink
• • <br /> E <br /> BUILDING PERMIT APPLICATION <br /> • <br /> EVERETT CiTY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON CONTACT then dropIN off FO completRMATIed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> ON:(P)425.257.8810 (E)everetteps@everettwa.gov 1(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) / PROJECT SITE INFORMATION <br /> 7 PROJECT SITE ADDRESS: STREET l7)-A Cast n o Rd( <br /> PARCEL#: 0 03g8r,3� 3190¢o)_ <br /> CITY tln>re STATE VA} ZIP q A�03 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: <br /> ' Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: YuAy ZIA-cot 9 <br /> OWNER MAILING ADDRESS: STREET f OOQ /1/& 11.4 +I p L <br /> cnY k,I t Low( STATE eft <br /> OWNER PHONE: 1 �?0` $� �� ZIP l o �� <br /> 8.�'� !OWNER EMAIL: •• vtnyi�,IQK.c V)1,(t pict 1_ ruln1. <br /> CONTRACTOR COMPANY NAME: DWIter <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY <br /> STATE ZIP <br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: INSOWNER ❑CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> l( l,0 6: Sr/y 3 6-0-ye <br /> LU4ty` CONTACT EMAIL: YNKY,s�kUvL y d9y1y,c./.1.(04"- <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ S O J !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: 1.142(A. ,,,.0 lit q <br /> PROPOSED USE OF BUILDING: .n.04 fcI„t/_ L,c <br /> HEAT SOURCE: ❑Gas Electric DOther ��JJ <br /> BUILDING TYPE: f1SFR OTownhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> TYPE OF PROJECT(check all that apply): DNew Construction DAddition NRemodel DRepair DT.I. DChange of Use <br /> DModular DPortable ORe-roof ElExterior Alteration DTank(above ground) DAccessory Str <br /> ❑Fence over 7ft high ❑RackStorage OPool/Hot Tub DTank(above ground) DOther: 2,, Q yea <br /> DESCRIPTION OF WORK: <br /> 4Giot c WA t L / el-8-e JAN 10 <br /> �i 2022 <br /> Pern ►t EVERETT <br /> SerViCeS <br /> ACKNOWLEDGEMENT./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 /> Gl /Oi ' I PE'9#��c y0( v ±___ <br /> owner/Authorized Agent Signature Date f <br /> (Revised 2/8/2021) //'/���- <br />