6300 MERRILL CREEK PKY SAFRAN 2023-12-08

BUILDING PERMIT APPLICATION D ECEDVE)EVERETT CIP OF EVERETT PERMIT SERVICESq tADO SUBMITTAL INSTRUCTIONS:See a licable submittal checklist for submittal re uirements um eo co i r d for r wASHINGTOw then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425-257-8810 (E) PermitServices@everettwa.gov (Ve+uTe tt(No ERETT (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Permit Services PROJECT SITE ADDRESS: 30 T ), C�)Z�Z i C al€t K ?AKIN y PARCEL#: y� i `CITY 4 V t Iz y/( I STATE (A/A ZIP V e3 SUITE/UNIT#: ICJ - 1 00 FLOOR#: `ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): A I-I? AI LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: NOR`Y e T LLc- OWNER MAILING ADDRESS: STREET I®Z 30 ,.e pal A 1 s Drt) V c Si.L J T ti LI I a J CITY a�'12 K L I"7N.,O STATE bti I ZIP g c3 033 OWNER PHONE:20 &/tog s.5-.2 OWNER EMAIL:SA rnSOA), 13 t NIW Bi.A . c © w% CONTRACTOR COMPANY NAME: / R I — -S./ ) . Roo)=)rV ) NC- WA STATE CONTRACTOR LICENSE# ) JIfIEtylg 0 ZZ f 13 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED$fa 335 CONTRACTOR ADDRESS: /7,s,Gt) 130 X ca`,3 7 CITY 1� �J €'V,�yA�, STATE ZIP g ecS ' CONTRACTOR PHONE: 2 53 ')30i J s-o CONTRACTOR EMAIL:TR -S TY ZROO F J n11 a J' • N' C 0 rel PRIMARY CONTACT: ❑OWNER / CONTRACTOR 17 OTHER(Please Specify) ,rCT//NAME:/ CONTACT PHONE: 206 36 / / J7 vl L VV O P`�/ CONTACT EMAIL.I J I . -S h'gIZ DO}T i/V� Q MS Al' 6.O W\ BUILDING INFORMATION VALUATION OF WORK:$ /3 3 j 0 7 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair marketalue� of all labor,materials,and equipment needed to complete the work,whether actually paid or not) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: .{./V PIA j r p ) HEAT SOURCE: LiGas ❑Electric [IOther BUILDING TYPE: ❑SFR ❑Townhouse LIDuplex LIADU ❑Multi-Family-#Units: MCommercial ❑Accessory Structure TYPE OF PROJECT(check��alll/l that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use EIModular ❑Portable Jr1Re-roof ❑Exterior Alteration ETank(above ground) ❑Accessory Structure `I Fence over 7ft high ❑RackStorage EPool/Hot Tub ❑Tank(above ground) TIOther: DESCRIPTION OF WORK: 1 NsiA L.L. o INA I L L C 4- e H1 G 1F- ® 7 O o c .5-/3 ti r'Yl t\!e n- lI € X IS`T i N s" is:t,d. R . 1 IV r A N N Iry p i1 f �= Nis )� c.D C) y *2 VV TriL 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 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 Building Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, and I ith the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# aY 3 z 23 306( - d Owner/Authorized Agent ign ture Date (Revised 4/21/2022)