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Now <br /> BUILNG 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)PermitServices@everettwa.gov 1(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) N PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET /0830 /T , ✓E $1- PARCEL#: Q <br /> CITY Et,0.e.StT STATE ,tJ ZIP t Z o <br /> SUITE/UNIT#: A $ FLOOR#: j sr ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): SiLvER L.A-K6', 0 JcP4-✓ <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: 14/p.. Lot No.: lJ/A- (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A1,301204 / S 1.+ot,/t7K0 <br /> OWNER MAILING ADDRESS: STREET /O83O 1'? A-itz 5� n' <br /> CITY V���77 STATE t Q ZIP f g2 v <br /> OWNER PHONE: 5/2 S 33. 3 s_ 7/3ti OWNER EMAIL: aupR,e V. OKc.l ( GINA.Wr!L , e ,I i <br /> CONTRACTOR COMPANY NAME: ° 9 Q W Iv lr k_ <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 rg OTHER(Please Specify) 24)2. hee...l'IToe..,nJi2 <br /> CONTACT NAME: CONTACT PHONE: /12,r 2,52- -Zl•S 3 <br /> MxNcc CONTACT EMAIL: Mikrt-5 , 'Z,BIZ,j�Rlhl-trEL-Tt)TEE . GON( <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ (ps OG9 0 ASSOCIATED LAND USE PROJECT#(if applicable): la <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: jQQtil.Tpq . <br /> PROPOSED USE OF BUILDING: p,01J^tp+rL 0PFt(�� <br /> HEAT SOURCE: ®Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ,Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction EAddition ❑Remodel ❑Repair ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ERackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> 5virrv. A <br /> '��P tJtj 'F�l�ST1 1,1/1 CI%Ft c 1UTv ADJA- -tor vilw'nl1"- <br /> 55' (Suer g' Tel -r 'POOR. <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 /> PPERMIT# <br /> Owner/A h Iz d gent Signature Date (Revised 4/21/2022) /J <br />