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E BIDING PERMIT APPLICATIfil <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 2404 74TH ST SE ' PARCEL#: 00398700400 <br /> crry EVERETT • sTATEWA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):HOMEOWNER <br /> LEGAL DESCRIPTION for new construction: Short Platlsubdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:WILLIAM VELASCO <br /> OWNER MAILING ADDRESS: STREET 2404 74TH ST SE <br /> cm EVERETT STATE WA zu. 98203 <br /> OWNER PHONE:425 737 8639 OWNER EMAIL: itbudbillv@yahoo.com <br /> CONTRACTOR COMPANY NAME:HOMEOWNER <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: 0 OWNER LICDNTRACTOR HER(Please Specify) <br /> CONTACT NAME:WILLIAM VELASCO CONTACT PHONE:425 737 8639 <br /> CONTACT EMAIL:itbudbillv@yahoo.com , <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$20000 ASSOCIATED LAND USE PROJECT S(if applicable):N/A <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:RESIDENTIALNACANT <br /> PROPOSED USE ILD . WNE ESIDENCE <br /> HEAT SOURCE: s ric r <br /> BUILDING TYPES R house ex U Family- ts: cial Structure <br /> • OF P T(check fiat apply •• Construe l o dition air ange of Use <br /> ■',. tar :1rtable ■ 1-roof Illgs-rior Alterati• MI nk(above ground) cessory Structure <br /> IN nee over 7ft high IN ckStorage ■ij• Hot Tub IN nk(above ground) UQiher:REMODEL <br /> DESCRIPTION OF WORK:Repair and remodel to an existing residential structures. <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.lam 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# D <br /> 7//(1(/(/(t-oemi ,,, („t4vaC/r 0/_../ -z.02 - ', 1.3,DL <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> yz <br />