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i <br /> BIDING PERMIT APPLICATIA <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 I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION,,'" <br /> PROJECT SITE ADDRESS: STREET gexk o Aj�1 �C1T' ��y�,."4174r3 i' Co h o P• j/ <br /> STATE /4./� (,ZIP 9 Jr�,©7 <br /> SUITE/UNIT#: 7747-2. FLOOR#: Z. ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):12,4,444/4- jOi/ ,�.�1 r/14#S <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:i3stp_11(c/!;s- /72e'<021)0r)au <br /> OWNER MAILING ADDRESS: STREET Z,/5 i<<j' //,fI a,ei,l' lF sD '`z j6 <br /> CITY 2-7 ).,/�.,4 CC STATE ZIP <br /> OWNER PHONE: 1/Q - EaZ 4, 47 OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: foSky Ra„G✓A/arion( . BLVSKRL $ S43t <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):W3-4 —7 '/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): z /9 3 <br /> CONTRACTOR ADDRESS: STREET /060 3 yr/ Vr surre, /-I <br /> CITY E6A rOj STATE (")113 ZIP 9'A v 5-7 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: t/Z� 757 gz.0 <br /> D wivis /(,et-u/ CONTACT EMAIL: 0.0tiNi,s KeLL yo6o/3zvs/Cr.Co lit <br /> BUILDING INFORMATION <br /> E VALUATION OF WORK:$ "-aae" 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: ,4Ye,Tvg&Aft ' OmES <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: ❑Gas ,Electric ❑Other <br /> BUILDING TYPE: ESFR ❑Townhouse ❑Duplex ❑ADU (]Multi-Family-#Units: /C7 ❑Commercial EAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑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 /> • R Wi9 02 , 'c`r��I c�co imonr /?cc* rito,55 CPC-62( /1/, /176 04/7/yer/M5lli <br /> ,3U<<o)eK t7a a, 6CD ,7b'tn/G p7r ge.-1Pini2�-S6/O'V 4e771//7-7 -5 <br /> Ra <&' o • 7xi( AA/a ComP 779,3 'IA/0 / <br /> //I! t.[KL'Xi-A!Q <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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �� / PERMIT# , 1°1 011 <br /> Owner/Authorized A nt gnature 'Date (Revised 2/8/2021) <br /> • IJz <br />