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MEI <br /> BDING PERMIT APPLICAWN <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)PermitServices@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 76O1- \ V(L \ock PARCEL#: L\ <br /> CITY K ( STATE W r\ ZIP y 5 z a <br /> SUITE/UNIT#: a FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME (if non-residential): \'Y), `LP gj i'12 f /U•eS r e n'1 <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L J1 I/(1 C k;1✓1 <br /> OWNER MAILING ADDRESS: STREET ('32_(4, 2 `6?j k (-SE �y <br /> CITY F L V're_4-1 STATE ) A ZIP 9 Co 2OF) <br /> OWNER PHONE: L,O(F 335 0-7 Z 0 OWNER EMAIL: C,(n un()C kt m oo. co <br /> CONTRACTOR COMPANY NAME: g L. T D ti .WA STATE CONTRACTOR LICENSE#(REQUIRED):3(-1SL! (2006NQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):3 7 7(oG <br /> CONTRACTOR ADDRESS: STREET ( t'( �0 b (0 I U r4' Pr V Y.. kJ G <br /> CITY F Ok j D+') C S STATE �` 1� ZIP I <br /> CONTRACTOR PHONE: Z 0( `-1 7 3 e-I 7 GI CONTRACTOR EMAIL: ‘i n C���\\'1�j co 0S r U )-:O'•i <br /> PRIMARY CONTACT: ❑OWNER >CONTRACTOR DTHER(Please Specify) _ �J <br /> CONTACT NAME: CONTACT PHONE: Sti e• c\ c:YJ 0 0.e.„ <br /> V►) ,\ C 4 ss`i A CONTACT EMAIL: S c,,rrl� c.:S c- \j U,% 'L <br /> . ",.t • BUILDING INFORMATION <br /> VALUATION OF WORK: $ 5 3(,9 . 1 I 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: ( 0 n 0 f C- O f"l <br /> PROPOSED USE OF BUILDING: 1���, c� ,^C �' (-Z.-- <br /> HEAT <br /> SOURCE: ;as )6ectric )ther <br /> BUILDING TYPE: ;FR ownhouse E)uplex [—VDU 11ulti-Family-#Units: :ommercial ccessory Structure <br /> TYPE OF PROJECT(check all that apply): Iew Construction ,ddition [lemodel r kepair 11.1. hange of Use <br /> Modular Elortable —le-roof :xterior Alteration r ank(above ground) ,ccessory Structure <br /> ence over 7ft high ;ackStorageTlool/Hot Tub ank(above ground) )ther: <br /> DESCRIPTION OF WORK: <br /> stillsIc7U , <br /> AdLCQ_ , `� n3 1- lLs Lea e ( - \D`•r J <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 /> Owner/Authorize ent lane re Date (Revised 4/21/2022) <br /> 17 <br />