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BRDING PERMIT APPLICATIN <br /> E�/E R E T T CITY OF EVERETT PERMIT SERVICES <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 II 2 O( S 6: 1(J 62 c_TT Atka PARdEL#: <br /> f <br /> t j /rCnY STATE �d /4- ♦ _.._.__ ZIP e`er e. <br /> SUITE/UNIT#: C.... 1 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): HOvt, u/v M j/4 <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:tilt teio ►4,9 (,i <br /> OWNER MAILING ADDRESS: STREET i °/ S6 E &f-..Ic 77- AI' ))it ,/ IA j <br /> EV _e ' CITY STATE - ZIP� ' Q <br /> PHONE: L 73 OWNER EMAIL: O.j I ` / .CO1'�- <br /> OWNER � �' d—( �V ,) I �� dZ.� � �[C7 <br /> T t ( <br /> CONTRACTOR COMPANY NAME: '1 G1 J,,� D (o k -- f>o_ /" <br /> � Y 7- <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):( ��131 DP qv ri ITY OF EVERETT BUSINESS LICENSE#(REQUIRED): e e <br /> CONTRACTOR ADDRESS: STREET/ 3J Lea.cI, ta4dAi <br /> CITY ll �0 )c STATE WA' ZIP0037 <br /> r w f �s S t <br /> CONTRACTOR PHONE: l ks (3 "'fs 3 3 CONTRACTOR EMAIL:_ 1 pse t�C? it2,S(? q M A e1, u PA' <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) „J <br /> CONTACT NAME: Sf9 E CONTACT PHONE: <br /> CONTACT EMAIL: <br /> 4 "'t' 11oo BUILDING INFORMATION, <br /> VALUATION OF WORK:$ i. r_ ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair marl of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: m - .5 ttG e k'e 0--6- ry <br /> HEAT SOURCE: ❑Gas Vlectric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Additionemodel ❑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: ith w p 3yvew , , y l 15. j eA1#+ M el zed 6`&Q <br /> (Lob rwci_ ©1VL <br /> ... 1.1 MAR 2 8 2024 <br /> CITY RPTT <br /> ACKNOWLEDGEMENT..I have reviewed this application and confirm the information contained herein is true and correct.Work done pursr��j44s e r u r c p4'""he <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must rs bbbttJ/i r nee <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 /> r�0 PERMIT# <br /> O L40_ -- (._-g_ <br /> ��,c / <br /> Ownwn er/ uthorized Agent Signature Date (Revised 4/21/2022) <br />