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Bl' DING PERMIT APPLICATW <br />CITY OF EVERETT PERMIT SERVICES <br />V E R E T T 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 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />Slue of Black Ink Only Please) PROJECT SITE INFORMATION <br />ROJECT SITE ADDRESS: STREET LJ 1 Q O OL' S S PARCEL #: Z 1.,E 00 <br />CITY '�t STATE, ZIP 96 V <br />JITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): fG S p� <br />=NANT/BUSINESS NAME (if non-residential): <br />;GAL DESCRIPTION for new construction: Short Plat/subdivision:J I Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />WNER NAME: •r uX EL <br />WNER MAILING ADDRESS: STREET V. 0 60 <br />CITY ` STATE W A ZIP • r% _ <br />WNER PHONE: %ii ZCj' .- r5C - 2 "j <br />OWNER EMAIL: <br />ONTRACTOR COMPANY NAME: / W Tf_j2-Fr_) S j il\l. <br />'A STATE CONTRACTOR LICENSE #(REQUIRED): (af'/�j �j <br />L}� <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />ONTRACTOR ADDRESS: STREET '} . C. i3G <br />CITY rZ S ue_N J STATE N,4 zip Q 25 y <br />ONTRACTOR PHONE: N'Z5- 08 - ,, ' G-5 <br />CONTRACTOR EMAIL: <br />21MARY CONTACT: ❑ OWNER ❑ CONTRACTOR MOTHER (Please Specify) (,ICI I I, e__NtjN1EjY— <br />ONTACT NAME: <br />r <br />CONTACT PHONE: 3(_- 0, t. r 2 o <br />CONTACT EMAIL:AC_ f- I 1 — <br />BUILDING INFORMATION <br />ILUATION OF WORK: $ 1ASSIOCIATED LAND USE PROJECT # (if applicable): <br />3luation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) <br />LISTING USE OF BUILDING: tv <br />20POSED USE OF BUILDING: _Sip JC <br />=AT SOURCE: ❑Gas Electric ❑Other <br />JILDING TYPE: WSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />.'PE OF PROJECT (check all that apply) : XNew 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 />=SCRIPTION OF WORK: <br />Pl00j(GSL-P Srrz ���1�wt (� G . W e S-)-- UVt S-C. <br />,KNOWLEDGEMENT.- 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 />rent 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 />ilding 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 />d I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # 'z -Lol <br />,ner/Authoriz6d Agent Signature I Dat (Revised 412112022) <br />��z <br />