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in BODING PERMIT APPLICAT N
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT 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 Back Ink Only Please) 'PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET`J y(1 - PARCEL#: r%C/6 S 11 c'a 20C, 1 tr
<br /> CITY V/.i ' " STATE J t'' ZIP ' .: s 2
<br /> SUITE/UNIT#: FLOOR#: -'"'""— ADDITIONAL LOCATION INFORMATION (if applicable): , m �c
<br /> TENANT/BUSINESS NAME(if non-residential): I..),L-:
<br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: -.."— Lot No.: ®— (attach copy of long legal description)
<br /> CONTAC INFORMATION',
<br /> OWNER NAME: - ,
<br /> OWNER MAILING ADDRESS: G,ItEET 1- LI " `„ YreA
<br /> CITY , , A STATE f�`j k ZIP 9`� '
<br /> /�,.I ?7t -- (7 OWNER EMAIL' , �!`� :_ e- e�/ ""':Jl la''' ,a..4 t; :1 ^:
<br /> OWNER PHONE: �`;���_ � � .�.�r I I �_.m �t � tt,.
<br /> CONTRACTOR COMPANY NAME: -40 F�to r -'-O{' s ill(_ A.tr l'D Plc(,+,L nl & (0-h,sr Li-1-
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): A RS/.((L 799 LS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> CONTRACTOR ADDRESS: STREET
<br /> CRY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> PRIMARY CONTACT: 0 OWNER/❑CONTRACTORLHER(Please Specify) /' t, 4
<br /> CONTACT NAME: Ri,�4-1' ) ? ®Y 17-el;iee CONTACT PHONE: 5 — - .. 0
<br /> yy7ii f, tx,,,,5 )y P0,A. i 11 .(''c. CONTACT EMAIL `, ) ).� i ` r/7 .11',! }'1'1.e(.E5 r'WI'1la,to avi
<br /> BUILDING INFORMATION ''
<br /> S ?y�tt
<br /> VALUATION OF WORK:$ Q) ` l ASSOCIATED LAND USE PROJECT#(if applicable): ki i,
<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: .')-F •
<br /> PROPOSED USE OF BUILDING: 1.Y ;-'
<br /> HEAT SOURCE: ❑Gas ❑Electric ,Other rt i . Pf .F'4 P
<br /> BUILDING TYPE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ECommercial ❑Accessory Structure
<br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel-F( pair ❑T.I. ❑Change of Use
<br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration DTank(above ground) ❑Accesso Struc 4N.7(t i
<br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other:
<br /> DESCRIPTION OF WORK: 1 <._
<br /> gf,,,,F0A'r- ,00:: P,..124r,kr AA--I Lin pc 4--)• at.Oirr N.a rel latAt, .'C‘ \f -'41 -#.
<br /> (,'1' revticialf, 9.Q., cairn iv--tek: 66-
<br /> gym tv\ , Rpotr-• 6e,i4 (ip oktA., Poo 1 \A,A6r1 iy. a\r A31 WA) ,6-12-C \
<br /> 4, (Ain t-I f�.?. 'k i t ,•£ ', . - S �V.\Ai ill, L-Wiet,
<br /> I:O 4ACIi(NOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and cor'reI.Work done pursuant to tit 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 Contract t rs Law 18.27 RCW and 296.200A WAC.
<br /> r E City of Everett Official Use Only
<br /> t � t PERMIT#
<br /> . , , ; A ',7t ,;) , , ' �' i5 do " 0(
<br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021)
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