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uLDING PERMIT APPLICAAN <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 I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 2 /—7 t: SC,,) PARCEL#: 0033 y300(06 706 <br /> CITY evPcie:> // I STATE ZIP / g..2_0 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'grne / iOU #01 <br /> OWNER MAILING ADDRESS: STREET /— 7 j' T" (59-6-t/L) <br /> / C�IfTY �e/'G STATE W ZIP g?2 <br /> OWNER PHONE: -/2-5-GII d 7S55_5" OWNER EMAIL: reI)- -L`1' C, t I7 O�`Na/ /. con-k.COMPANY NAME: e A Q-Tel-- Co 1)9 IP�Dli-OCT (() (� Q <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CAP-TECT l CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): '�' ?ZT 4g <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �I��ij,r j'j'70/. L, rt CONTACT PHONE: 9 -c '���_ �j.]6�2 <br /> G�2"5-- . , (�3 Z r7 CONTACT EMAIL: T.-C.c., 59 L. @ /C}�C . 'din <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ / 600 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair ma et value of all tabor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: ❑Gas Electric ❑Other <br /> BUILDING TYPE:'SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ritAddition ❑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) ❑Other: <br /> DESCRIPTION OF WORK: <br /> PACtit)(0 JOY -Jr) k Pe-oy-v.-(- 0 9 0-6V-S-C )‘ YD <br /> pddiit ) 1'Z- ) ZAck o P ose r�. ' <br /> -� n 0O—I <br /> a � i�u► (� <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 tam 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 /> 1Z12.--- PERtT� <br /> 0 ' FT orized Agent Signs ure Date (Revised 2/8/2021) <br /> 112_ <br />