Laserfiche WebLink
me BRLDING PERMIT APPL.ICATIR <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)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET thf e- �, <br /> Z 0 j 1 Z 4h S4- Sg PARCEL#: O0 q 5 O 71 '/ op <br /> CM et o STATE �j 14 ZIP 9 0 0 E <br /> SUITEIUNIT#: ' 9 j FLOOR#: ADDITIONAL LOCATION INFORMATION(if applicable): <br /> TENANTIBUSINESS NAME(if non-residential): <br /> ' LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (`',}I/1�J�Irl run i-lo I In&Jay OWNER MAILING ADDRESS: STREET 42.0 jot 0 I i 2 S4 S "rrcvt I r <br /> ec 1 4 r p(� /y <br /> CITY.r V A re 44 STATE A �7ZI l 9 ZV <br /> OWNER PHONE: LI --- 7s(9--s-673 OWNER EMAIL: Cunt jV.SimnioYES' s/ 0 YAA0QiGOM <br /> CONTRACTOR COMPANY NAME: ,1s'4-e. ri� 13 u i 14- CMS U eTlt co <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): ZA}tt4 Op q7atTICITY OF EVERETT BUSINESS LICENSE#(REQUIRED):6,53961 <br /> CONTRACTOR ADDRESS: STREET ? 2,2 ? ent.c c a d(h Dr <br /> err £vP rP_t+ STATE ill' ziP 9 ife2 2? <br /> CONTRACTOR PHONE: y2S- 9 - it L1p2$ CONTRACTOR EMAIL: 1/5--eU y���y e en ► U. C.�9M4 r'�. <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR El OTHER(Please Specify) �J <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 700, Oa ASSOCIATED LAND USE PROJECT#(if applicable): <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: <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: DGas ❑Electric DOther <br /> BUILDING TYPE: DSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition DRemodel Mepair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof DExterior Alteration ❑Tank(above ground) ['Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) DOther: <br /> DESCRIPTION OF WORK: <br /> ChCNn9e. Ov+ 3 alumiAu04 gt.JI1 ,As, pas-1- w;4-A LI*V Pressure <br /> Tree,+eta P 0s- <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.lam the owner,or!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 WAG. <br /> Grly of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br /> 1 <br /> Iz <br />