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az B JILDING PERMIT APPLICAI ._,N <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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 4916 24th Ave.W. PARCEL#: 00567900400404 <br /> clrr Everett STATE WA ZIP 98203 <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.. Seaview Heights Lot No:4 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:4900 24th Ave. W., LLC <br /> OWNER MAILING ADDRESS: STREET 526 N. West Ave. #147 <br /> on-., Arlington STATE WA ZIP 98223 <br /> OWNER PHONE:360-631-5922 x 3 OWNER EMAIL: officemanager@fullwilerconstruction.com <br /> CONTRACTOR COMPANY NAME:Fullwiler Construction Inc. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):FULLWCI9O3M2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET526 N. West Ave. #147 <br /> cITy Arlington STATE WA ZIP 98223 <br /> CONTRACTOR PHONE:360-631-5922 x 3 CONTRACTOR EMAIL:officemanager@fullwilerconstruction.com <br /> PRIMARY CONTACT: ❑OWNER ©CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360-631-5922 x 3 /425-344-7803 <br /> Mallorie Hefley or Jerry Fullwiler CONTACT EMAIL:officemanager©fullwilerconstruction.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$300,000 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:NOne - new construction <br /> PROPOSED USE OF BUILDING:Single family home <br /> HEAT SOURCE: ❑✓Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: LiCommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ©New Construction ❑Addition ❑Remodel CI Repair DTI. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> El Fence over 7ft high ❑RackStorage EPool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Construct new 2-story single family home with attached garage <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 /> PE T;#___ <br /> L'�o 1� —0k-A <br /> Owner/Authorized Agent Sig ature Date (Revised 2/8/2021) <br />