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MEM <br /> BUILDIIIIG PERMIT APPLICATION• <br /> EVERETT C TY OF EVERETT PERM T SERV CES <br /> SUBM TTAL NSTRUCT ONS: See app icab e submitta check ist for submitta requirements and number of copies required for review, <br /> WASHINGTON then drop off comp eted app ication pus a required submitta documents to 3200 Cedar Street 2nd F oor ntake Drop Box <br /> CONTACT NFORMAT ON: (P)425 257 8810 (E)PermitServices@everettwa gov (W)everettwa gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT S TE ADDRESS: STREET gooL (Al It WON )y PARCEL#: 009315722Q290 I <br /> C TY E Y Tr STATE Wq Z P 4 u 2 <br /> SU TE/UN T#: FLOOR#: ADD T ONAL LOCAT ON NFORMAT ON (if app icab e): <br /> TENANT/BUS NESS NAME(if non residentia): <br /> LEGAL DESCR PT ON for new construction: Short P at/subdivision: Lot No: (attach copy of ong ega description) <br /> CONTACT INFORMATION' <br /> OWNER NAME: AY{t I gi <br /> 'OWNER MA L NG ADDRESS: STREET (p)OS�pj I114 PL NE p', ^,� A <br /> CTY I�N�jVIIIC. STATE l ZP lr8�-T <br /> OWNER PHONE: OWNER EMA L: <br /> 'CONTRACTOR COMPANY NAME: CNA) �-- <br /> WA STATE CONTRACTOR L CENSE#(REQU RED): C TY OF EVERETT BUS NESS L CENSE#(REQU RED): <br /> CONTRACTOR ADDRESS: STREET <br /> C TY STATE Z P <br /> CONTRACTOR PHONE: CONTRACTOR EMA L: <br /> PR MARY CONTACT: g OWNER ❑CONTRACTOR ❑OTHER(P ease Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 Is 34S-4 Gl1 <br /> AM-trPg_ Nara CONTACT EMA L: S►r ztyy ry i-141% 0..NAB•to m <br /> BUILDING INFORMATION <br /> VALUAT ON OF WORK: $ rj 0,07) .(, 4SSOC ATED LAND USE PROJECT#(if app icab e): <br /> (Vs uation sha incude the prevai ing f ' arket va ue of a a or,materia s,and equipment needed to comp ete the work,whether actua y paid or not) <br /> EXSTNGUSEOFBULDNG: MOble... <br /> PROPOSED USE OF BU LD NG: <br /> HEAT SOURCE: ❑Gas ❑E ectric ❑Other <br /> BU LD NG TYPE: SFR ❑Townhouse ❑Dup ex ❑ADU ❑Mu ti Fami y #Units: ❑Commercia ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remode ❑Repair ❑T ❑Change of Use <br /> ❑Modu ar ❑Portab e ❑Re roof ❑Exterior A teration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Poo/Hot Tub ❑Tank(above ground) other: <br /> DESCR PT ON OF WORK: <br /> gt,i't&tij QahO deck-- , vutide. of A. irk.►-c, bleitolow. <br /> A v` =4.0 <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 /> /,� <br /> �0. oS/f�(Of�� I" <br /> I PERM 5-iibo <br /> 500' <br />