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0 <br />ALDING PERMIT APPLICAAN <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) 425.257.88101 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 10209 1ST DR SE PARCEL #: 00396900001100 <br />clTv EVERETT STATE WA zIP 98208 <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: Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME:ANDREW STEELE & CHRISTINA NEIL <br />OWNER MAILING ADDRESS: STREET 10209 1ST DR SE <br />,Tv EVERETT STATE WA zIP 98208 <br />OWNER PHONE: <br />OWNER EMAIL: andrewsteele560@yahoo.com <br />CONTRACTOR COMPANY NAME: <br />WA STATE CONTRACTOR LICENSE #(REQUIRED) <br />n <br />I ERETT BUSINESS LICENSE #(REQUIRED): L�S <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) AGENT <br />CONTACT NAME: <br />Elizabeth Clay <br />CONTACT PHONE:206.660.0$90 <br />CONTACT EMAIL: ellzabeth claydeSlgnIIC.OnmICrOSOft.COm <br />BUILDING INFORMATION <br />VALUATION OF WOR : $50,000 ASSOCIATED LAND USE PROJECT # (if applicable): <br />(Valuation shall include the prevailing fair market vgMe of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) <br />EXISTING USE OF BUILDING:SFR <br />PROPOSED USE OF BUILDING:SFR <br />HEAT SOURCE: ❑Gas ❑Electric ❑Other <br />BUILDING TYPE: "SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />TYPE OF PROJECT (check all that apply) : El New Construction ❑Addition Remodel ❑Repair ❑T.I. []Change of Use <br />❑Modular ❑Portable ❑Re -roof El Exterior Alteration ❑Tank (above ground) ❑Accessory Structure <br />❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other: <br />DESCRIPTION OF WORK: INTERIOR REMODEL OF EXISTING SINGLE-FAMILY RESIDENCE. <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 />PT? <br />(Revised 21812021) <br />VZ_ <br />