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IJILDING PERMIT APPLICA�ON <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)everetteps@everettwa.gov 1(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET � �9PARCEL#: L' �^ <br /> CITY Z..'!� G I L—77 STATE U/,� ZIP 9(�'o�J8- <br /> SUITE/UNIT#: Q FLOOR#: / ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): Cei--on Qayf QO Ems-j <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> / f/ CONTACT INFORMATION <br /> L/tGh l� <br /> OWNER NAME: , S /re,, A fQ4-7 p� <br /> OWNER MAILING ADDRESS: STREET 9(OS /cy <br /> CnY p Qc/h7 (phi/ STATE V./T ZIP 9a'o$ 2 <br /> OWNER PHONE: „20 6 a3 / OWNER EMAIL: t/4 ACy v0 Q;/.44 <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: DINNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: ‘,9Q 6 .2„3 9 //9 I <br /> ( /,, f`c c (/�S� CONTACT EMAIL: 1./k A. C+//V 2 Q.. /Al2 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ POO& 00 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: VAC t7"/7 / SP' A-C£ <br /> PROPOSED USE OF BUILDING: 4-?pc.et <br /> HEAT SOURCE: alU`as ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: CPGommercial ❑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) E6ther: A�abka ,c�S f r �!tt�Ieyl <br /> DESCRIPTION OF WORK: <br /> ct(° l74' � �- /� I A -4 S 7cod-,v. Q - <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 Everreettt O/ficiiall Use Only <br /> PERMIT# p 2 (�V G 038 <br /> Owner/Au o d Agent Signature Date (Revised 2/8/2021) <br /> � I� <br />