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1 BAILING PERMIT APPLICATIA D CE EINE '11 <br /> CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requireme t; d nukd ofIcgpie''nnf 2 uired fcIview, <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 j(NPere&F.EVERETT <br /> (Blue or Black Ink Only Please) cPPROJECT SITE INFORMATION Permit Services <br /> PROJECT SITE ADDRESS: STREET 31 if cf:bti: E°L ,S' l PARCEL#:CITY f ve /l STATE WI,- ZIP /rd'�'/ <br /> Q. <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: SPICE/ O B/s0A <br /> OWNER MAILING ADDRESS: STREET 3/9 IRA p .S'LJ <br /> CITY El/Xi/if/T STATE/ /.5 j"Z' ad". ZIP !��LT <br /> OWNER PHONE: .., V),�' ,.... �. ...,. - ... OWNER EMAIL: vV ���,//// <br /> CONTRACTOR COMPANY NAME: lY(, iw a ,C�j -efS ►f next//ct <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):74A/'(&{ d(I.ZJC,2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D/gyp,j 43 <br /> CONTRACTOR ADDRESS: STREET360( 4"5/fj 7' 4Q '2 <br /> CIITYr(� Eke/if f// STATE �,/�4r /� ,'/ZIP 9/ 0 <br /> CONTRACTOR PHONE: <br /> ykse. .LS / ,A/t'p lll/ t.._...._ CONTRACTOR EMAIL d'edes..�Jed i„,a,.. e eciiC(G ,.. Ad- <br /> PRIMARY , ... <br /> CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y,6 3f A 75 <br /> O 9I'M f .- CONTACT EMAIL: eel kike P IITJ L ' kopt 011 <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ /j DC 7 ASSOCIATED LAND USE PROJECT#(if applicable): / pc`ir -_. (pZ <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: S'FIL <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE:pgFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: El Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction DAddition El Remodel CI Repair ❑T.I. ❑Change of Use <br /> CI Modular ❑Portable El Re-roof ❑Exterior Alteration OTank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage tool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> Rgpict dyo v -r rf07-- 71)6 w rTt 1/oLf <br /> 1-0 r 3 '98 is o wMck P72_6V J i) 0 <br /> M, tier It V g kic L©Ce-htt) 2� <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# <br /> J/S <br /> ner/Authorized A nt Signature ate (Revised 4/21/2022) <br /> 1p3 <br />