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INN <br /> BUILDING PERMIT APPLICATION <br /> E E R G T T CITY OP EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal chec clist for submittal requirements and number of copies required for review, <br /> WAsr+rNGTON then drop off completed application plus all required submittal documents to 3200-Cedar Street 2nd"Floor Intelte-DropBok <br /> CONTACT INFORMATION:(fs)425=257 8810 J(EJ PermitServicestteverrettwa g©v J(W)•everettwa gcty/permits <br /> ra �c� 119�� $T ! ATuQ <br /> PROJECTSITE'/ADDR S aTREaT l " —" t 5V PARc*L#• O 5 1 t 6O.1 a orrr U-est- j.4, • s A t,SA q i•tat f <br /> SUITE/UNIT# PLOOR#; ADDITIONAL LOCATION INFORMATION•(if appliable);, <br /> • <br /> TENANT/BUSINESS NAME(if non-resfcientia : <br /> LEGAL DESCRIPTION to'pew oonstruotion: Short Piat/subdivisiin: Lot (a `copy:orf long Legal de$ori o) <br /> OWNER NAME: 'et •I"� U s` Otre, " . ((k• r; t}+'c'' <br /> OWNER.MAILING ADDRESS:• •STRSET t'-. ( at,t S <br /> cm( -V e.cr.1l stATE 9 T a 6 <br /> OWNER;PHONE: '. (o q(Q- 67-7 . QINNER EMAIL t'Q I+'I it..ti>rx c t4 t �,,E, k,t�l, e 0tN.. <br /> CONTRACTQR GQNIP'ANY NAM �nsj,t'tu�h rsv+ <br /> E: (1 e i! �.r��' f CA� "iT <br /> �� :r�c1 ,, t <br /> WA STATE CONTRACTOR LICENSE•#(REQuIRED): ,CITY€tF EVERETrSUSINES: UGENSE#(REC tiiftE0): <br /> CONTRACTORADDRESS: STRt:ET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE CONTRACTOR EMAIL: <br /> PRIMARY-CONTACT:„OWNER CT CONTRACTOR Q OTHER(Please Specify) <br /> CONTACT NAME: ^` CONTACT PHONE: <br /> lv�� lam' , <br /> CONTACT EMAIL• <br /> lp 1 ti <br /> VALUATION OF°WORK:$ ASSOCIATED LAND•USE:PROJECT#(if apptitable): <br /> (yaidaUaa shall iridude-the prevailingfair madcetw�e..of 11 labor,materials;and equipmentpeeded•t000molete itle work,whetherautuallypaikt ernotzj°- <br /> EXISTING USE OF BUILDING: <br /> USE OF.BUILDING: <br /> HEAT SOURCE: ° OGas CElectric C .Other <br /> BUILDING TYPE: greFR CDTctwnhouse • ClDuptex •C]ARU ClMutti i=aizlit r-#Units; DCorr merctal QAccesso y Structure <br /> 1'�lPE OF PROJECT'"{check all thatapply)•t QNew Construction QAdclitibn ORem del Ql2epalr CIT.i C3Change of tyae <br /> Q.ftt dtilar QPortabte QR.e-roof Extsrior Alteret on i0Tanie(above ground) OMcessoryr Structure• <br /> 0.portoit over 7ft high I RackStorage DPgolHbt Tutu 'QTank.(above.ground) C1Other:. . ..,, , <br /> DESCRIPTION OF WORK: <br /> f ct 60,41ftp0w _ r covA bec Otl' wattTi dcs .a v re. .1t5 • <br /> ACKNpt t2EDGEMENr.i have reviewed this epp11W/on and conimm the,information contained herein(stye• and correct Work• clone pursr ent to this.serml(must cpmpil wlth <br /> current federal,state,and local law The granttng:.of a pemiif only authorizes approved work and ncr:deviallons therefrom Deviations, must frst be atrtl o#zed'in writing.from the <br /> Building-Mk/at before being authorized under anycircumstance,I am the owner,or/am authorizer/bythe Owner oft/tie property to perform the Work foktrhich application,is made. <br /> and!comply with the.State:Contractors lap and,296,200AWAG <br /> City fEverettpffictal Use.Cnty <br /> 7 93f 2O2 Tc(k2 - O <br /> OwnsrlAuthorizad:Apenk$lonafure. • Dos'. (ftevfsed"dd2 f1t7221 <br />