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_ • • <br /> ra, BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 7c71 75+k 5-+- 5 EE PARCEL#: <br /> CITY fVeYe STATE W J. ZIP if 2,03 <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: W I IIra 5 Tnve 4 enr(s <br /> OWNER MAILING ADDRESS: STREET ZS / 7 Colby- Ave- <br /> CITY V VCNL± STATE WA— ZIP et 0( <br /> OWNER PHONE: OWNER EMAIL: <br /> h CONTRACTOR COMPANY NAME: itif-Ir- (6etS4YG(GTLrOK_ i i (-- <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):w trN HCg3zK5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 270`( <br /> CONTRACTOR ADDRESS: STREET Z ( (3Z S `4 Roes!y&( yck <br /> CITY sn.oh dill/JA < STATE ("id- ZIP l8ZItO <br /> CONTRACTOR PHONE: C2S- 7 'O ZS Q CONTRACTOR EMAIL: (4)0C—LLGOSO C G/klat 1, GDP <br /> PRIMARY CONTACT: ❑OWNER IK CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / / / CONTACT PHONE: (�2 5` �77 -d .S0 <br /> i7�CAae! 41)41 Kd CONTACT EMAIL: (Aj(„)C�,LCB�6 ® 6,,,A /. GQm <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ f/0/000, ©O 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: ri,lwjfi fa. ( Res er. <br /> PROPOSED USE OF BUILDING: rt(,u (� , lf'R/'�1i1 RLSf e t4t <br /> HEAT SOURCE: ❑Gas 1lectric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ®Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ElNew Construction ❑Addition ❑Remodel ❑Repair ❑T.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 /> ( emc)16.( CU/ �lZ, 715, 1/6, Yz1, qlL, ,q35, (136, 4'i5 <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 /> 7 City of Everett Official Use Only <br /> 2-15-Z2 PER <br /> ZZO?j-�ot <br /> Owner/Authorized Agent Ignature Date (Revised 2/8/2021) <br /> 8-e-r ;,f <br />