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B!LDING PERMIT APPLICATION <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 l(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 5020 Sperry Ln PARCEL#: 00402900000900 <br /> CITY Everett STATE WA zip 98203 <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:LEE DAVID B <br /> OWNER MAILING ADDRESS: STREET 5020 Sperry Ln <br /> CITY Everett STATE WA zip 98203 <br /> OWNER PHONE:425-257-1144 OWNER EMAIL: jarvis1077@yahoo.com <br /> CONTRACTOR COMPANY NAME:Owner to act as contractor <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Owner's Agent <br /> CONTACT NAME: CONTACT PHONE:206 432 1111 <br /> Ethan Pe rri g o u e CONTACT EMAIL:ethan@yendes.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $69233 ASSOCIATED LAND USE PROJECT#(if applicable):REVI21-050 <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:Single Family Residence <br /> PROPOSED USE OF BUILDING:Single Family Residence <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): ENew 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 /> Interior remodel to existing SFR. Repairing fire damaged detached garage like for like. <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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 11/17/2021 — <br /> 1 " I <br /> Owner Authorized Agent Si ature Date (Revised 2/8/2021) <br />