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BU!DING PERMIT APPLICATIO mm CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET $1 Dit,..w Iles Ivy PARCEL#: CITY r:veye.tt\\\' STATE W _ZIP c SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): J(jy dir1TI.,V- U.)11lkai'1 + ly- 1j' a i\-toop 1'I LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: L (attach copy of long legal description) CONTACT 1�IttN FORMATION r Z ) OWNER NAME: TO nreA, Ili iryir Lv r v1 4- k� ??M-Ze.. R ftOY01:l./,. OWNER MAILING ADDRESS: STREET /6`-021. 6/AAA Waki 0 V� CITY KO t I kO J STATE WA, ZIP q 8 VT,S OWNER PHONE: t $ - NO- a/s-t OWNER EMAIL: bf i,Gt,, ill, Al tJ r Py\,L, l3.r1-t7.t.�1 • COrY1 CONTRACTOR COMPANY NAME: NE J WA STATE CONTRACTOR LICENSE#(REQUIRED): Nek^Co CL q(2)43 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):jt-ee ? z(Lr 14N CONTRACTOR ADDRESS: STREET p 7't✓- 73 /Si �' 9 . St- CITY ,- r'A 7 i55 )(AkA STATE Kik- ZIP 780 Z 7 CONTRACTOR PHONE: CONTRACTOR EMAIL: /�eGN y e tMb dt g 14 n o„ C b-I PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: r CONTACT PHONE:, C3(6,p)25 1_8sn JbatLIATZkV\ 'b,)t('IlAt,v+n CONTACT EMAIL: )Pw i t hol-y-h ,i I , obv+n __�� /�� BUILDING INFORMATION VALUATION OF WORK:$ 5 C5(�D ‘G�f �N. p Q Ofi�ATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing f ' ma et value of all labor,m nals,a`if�dd`'eq ``ipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: r 1 ,p,n}CCk,t PROPOSED USE OF BUILDING: ( j ip,y1 k/A,t HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: I SFR ❑Townhouse ❑Duplex ❑ADU ElMulti-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition Nemodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: iUA irt,)tte Hie. }t ou e. 1 \ � ,, te oS eowteu,, , ahe� w1. t1 ct ktreC5 UP y,,, tooi1ti. LU t1 add i''ik',-o'- Lou.Il$ f, Corre c,l- ito1A. cvoClyg,\ --kcx0 - 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 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 Building Official before being authorized under circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors L 18.2 RCW and 296.200A WAC. City of Everett Official Use Only C-7 PERMIT# i2. 10(1 - O Smg ��18 f Zo�-Z Owner/Authorized Agent Signature Date (Revised 2/8/2021) 1/a