Laserfiche WebLink
Itlllll■ BUILSO PERMIT APPLICATION <br /> number of�,ptes re9ulred for revl�• <br /> E V E R E T T SUBMITTAL INSTRUCTIONS:See opp r eveuta Wire ehedclisll or;subr Ial requIremenls and Drop BOX, <br /> WAr NuraroN then drop off comply-ledp application us ell required submittal documents to;l20d Cedar S(reet o�io�mlts <br /> CONTACT INFORMTION: )g25.g6 4810 I(E)permilServicesfieverettwa,gov (W)averellwa 9 p <br /> (Blue or Black Ink Only Neese) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS; srscEr 3208 21ST STREET PARCELS: 98201 <br /> Cm EVERE Y STATE VVA <br /> SUITE1UNIT# FLOOR : ADDITIONAL LOCATION INFORMATION(if a Ube) ..-------� <br /> TENANTIBUSINESS NAME(it nonresidential): of long legal description) <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision- • <br /> LotNo,; (ausoh coPY •••� <br /> CONTACT INFORMATIION <br /> OWNER NAME:AB©OULIE NJIE/NDEY-ARAM NJIE <br /> OWNER MAILING ADDRESS; STREET 2021 139TH STREET SW � 9$087 <br /> caer LYNNWOOD STATE WA <br /> OWNER PHONE;206-227-4452 IOWNERI MAIL:abduInjiet gma'Ii.com <br /> CONTRACTOR COMPANY NAME: Al3i)DULI E NJ le <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): (CITY OF EVERETT BUSINESS LICENSE 1(REQUIREDr <br /> CONTRACTOR ADDRESS: sntmEr <br /> zos <br /> CITY <br /> STATE <br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-227-4452 <br /> ABD U L NJIE CONTACT EMAIL:ABDULNJIE@GMAIL.COM <br /> y�# BUILDING INFORMATION <br /> VALUATION OF WORK:; C /� <br /> va 'ASSOCIATED LAND USE PROJECTS(i(applicable): ,... <br /> (Valuation straw Subtle the prove felrmedlol a of glibber.mataAsb.and equipment needed Ia complete the work,*tether actually paid of nat.) <br /> EXISTING USE OF BUILDING: f?7fliiL.'( Jf Orn <br /> PROPOSED USE OF BUILDING: it-0 UCT 1trrl t 14 Ito 7 to <br /> HEAT SOURCE: OGas DEtectrlo Daher <br /> BUILDING TYPE: OSFR DTownhouse DDuplex DADU DMu!(i-Family-#Units: OCommerdal DAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction DAddiUon ©Remodel DRepair ❑T.l. OChange of Use <br /> OModular OPortable ORe-root °Exterior Alteration °Tank(above ground) DAccessory Structure <br /> OFence over lit high ❑RackStorage DPoollHot Tub Drank(above ground) DOiher: <br /> DESCRIPTION OF WOR�tegz, ' ( r Ii IC l oT1E <br /> • <br /> ACKNOWLEDGEMENT;t hiwo ravfewad Odd AppUcaUat and confirm fie mark sd►n de fs ris the eimmf.WArk done Plasuini io this <br /> pr� ntlddee 4 etAra, soy at n . um a kY eroffhb'a iy o po must tbelly the rrro''uetn t me <br /> nldroearlw. <br /> Bulking 4be6natrelh0auHod UM!82TRCWend20826AN wAa !rforwhlc,spP►eatlorttaMade. <br /> Ind r Y "Stall Coaheclo�+ Cxyot Everett <br /> PERMIT# Dll�rd use artn, <br /> 1 fiCiriPl" <br /> Date (Revised 41214024 <br /> ✓ I O V /Z <br /> Owned sod Agent Signature <br /> ®CamScanner <br />