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BUILONG PERMIT APPLICATIO+
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETTSUBMITTAL 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 I (W)everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET I Or) j;i_ic.() Jra✓` PARCEL#: l
<br /> CITY ‘ e,J'2-t }/ STATE 'VIA ZIP C1 0. 0 i
<br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable):
<br /> TENANT/BUSINESS NAME (if non-residential): C.oy.\', ,n's FV(v..a4-vv-e.
<br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: C c v,1',na •
<br /> �:,r"t "4ti,.4...
<br /> OWNER MAILING ADDRESS: STREET .)1\ L j g r O c-a)i- -6 l
<br /> CITY L /x`�1 \\' STATE q f/1 i/ 3 e.)ZIP ,
<br /> 0
<br /> OWNER PHONE: 400 )C 4I - (,,13.�., OWNER EMAIL: 6 ('y,tiy� -�i.,'\-�h .e SC�V, i.e)cc v,t;A.t . C,,:,A,
<br /> CONTRACTOR COMPANY NAME: _Shv%--e,S (,ar,S�'y✓C,4-;c .:,4.--poi%) LL C
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):_`,>11t{UC�4=LL'r('?? 5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C-,C77 `-k `-I
<br /> CONTRACTOR ADDRESS: STREET ,CI (t'I U,-,k-z _> ,%v
<br /> CITY ��J....a,' it * STATE M," A ZIP CI CO c'
<br /> CONTRACTOR PHONE: Cl - 3 `Tel—,3.13 U CONTRACTOR EMAIL: jiell ( i 1.,,;,,.e S e<9 ti,5i-;'„_ 4.,..,.-, r c.,Ay,c. ::-.,
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: "4.Q C, , a5"4i— Gi 3 Ci
<br /> ( I z ( l S1\Ct c'c' S CONTACT EMAIL:C le(( & _\ :�> c,>, ,sfi.�;.'t.'.: 4;:: -.,In,._.,., ,
<br /> BUILDING INFORMATION
<br /> VALUATION OF WORK: $ ). 'J,0 0 .) 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: FU Yr1 -1-.,i.-E >'�c�,'-
<br /> PROPOSED USE OF BUILDING: ` 1
<br /> HEAT SOURCE: ,K.Gas ❑Electric ❑Other
<br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure
<br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair 6T.I. ❑Change of Use
<br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure
<br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other:
<br /> DESCRIPTION OF WORK:
<br /> ;;At e t5 LAA\\ i"J C f a G-'f-e o,`)t ‘.t,"t.,k Ip i.C V-sr o ...s.
<br /> NImay,- I,-he,,,4 -..Yc-.1 tic,,\c) < A - I' ` -C$./'c ..\ t`t''v f�i✓/01,N p.%1 A.,-k- i I, ,A r✓0"?
<br /> p [ CIEOV[E ,
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<br /> SFP ,I
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the inform4tion contained herein is truU(a11d 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.l am authorized by the owneroi 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 /> .. --7s.,...._____
<br /> el/a Voil;7 PERMIT#
<br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022)
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