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E BUILAG PERMIT APPLICATIOKID <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 I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1203-NI S SSuet1t WIL./ayPARCEL#: <br /> Z-; .•ccrci u, ^ LIP 9$2OS i <br /> iSU1TE/UNIT#: N FLOOR#: 2 ADDITIONAL LOCATION INFORMATION (if applicable): I <br /> 3 <br /> TENANT/BUSINESS NAME(if non-residential): r t c IC 5 `4 mil \I n t-t'i 15 <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> f <br /> CONTACT INFORMATION <br /> OWNER NAME: Nei..., T-e✓1 er + . TQvky /S+2ct e_ C pelt t <br /> IOWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: (, P—30 7 ^ 2(0 -i 2_ OWNER EMAIL: cS c \e y. w 2 &bricks and m;Ai Av.co <br /> CONTRACTOR COMPANY NAME: jcoA Siva cp SilA&1S L-LG <br /> I <br /> T <br /> iWA STATE CONTRACTOR LICENSE#(REQUIRED): .L-RON S5S-772DjCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 657.2 7_ j <br /> 'CONTRACTOR ADDRESS: STREET 'i$) J Iii, VefilisaN Dr. <br /> CITY _Eve rt ki STATE w A ZIP 142.01 <br /> CONTRACTOR PHONE: `l 2S-2 (0 —0 O CAZ CONTRACTOR EMAIL: Tc ov $i a r IAS S a tin 11. C A 8.4-1 <br /> PRIMARY CONTACT: ❑OWNER [ONTRACTOR )THER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Li 2 5--- 2 to -Qp 4o .i <br /> • <br /> 3-2mI e., E (51VL 2( CONTACT EMAIL: ,Tccr4Sl�2c p5-h.dS a nn,...n.[O�t <br /> BUILDING INFORMATION <br /> VALUATION OF WOR :$ �/lf�0o ASSOCIATED LAND USE PROJECT#(if applicable): <br /> ('valuation shall include the p Availing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) I <br /> 'EXISTING USE OF BiILDING: llk rr 2tA k- <br /> PROPOSED USE OF BUILDING: e q(O/To S 4-0 c e_ <br /> HEAT SOURCE: ;as [lectric Tther P P . �fi not., <br /> BUILDING TYPE:_;FR Lownhouseluplex F,DU [ ulti-Family-#Units: l Fommercial F.ccessory Structure <br /> TYPE OF PROJECT(check all that apply): lew Construction ,ddition [emodel r Tepair ji. :hange of Use <br /> lodular 'ortable e-roof .xterior Alteration ank(above ground) ,ccessory Structure <br /> ence over 7ft high :ackStorage 'ool/Hot Tub ank(above ground) )ther: <br /> DESCRIPTION OF WORK: <br /> EX+ 1CX n ie -e-X %5`61"\ rear►�e. o43- t'3‘ -ro beco Qe(4-1 coo <br /> -Pb r t 1 cncka'j5 . Then 20ita i +L')v Se pe re:4 a tAr o\t.5 `b <br /> Cct!vc . -.Dr ©•ecce 2w S4� o zc r roe ^ - evtf' -{-A 1 t° 19Z <br /> Mtki ex i si-i v5 54-6 s a S I'S. ' -t..o t- ? [c a rrt <br /> -54rv►t� vtaI fo bwl'Id� M v`bw�- w.1l 11akit_ br2c SiK . <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 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Z z9/ZS 1 PE TL\ACA aa� <br /> Ow r A orized A ignature Dat (Revised 4/21/2022) <br />