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BALDING PERMIT APPLICAI .JN <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 4721 bayview lane PARCEL#: 00417000400201 <br /> CRY everett STATE we ZIP 98203 <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:ryan wright <br /> OWNER MAILING ADDRESS: STREET 4721 bayview lane <br /> CITY everett STATE wa ZIP 98203 <br /> OWNER PHONE:2067949002 OWNER EMAIL: ryanwrightl369@gmail.com <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS L E SE 13E / <br /> CONTRACTOR ADDRESS: STREET +U G <br /> CITY STATE 4 <br /> QAQI <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CITY OF EV <br /> CONTACT NAME: CONTACT PHONE:2067949002 Permit <br /> ryan Wright CONTACT EMAIL:ryanwrightl369@gmail.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$30000 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:home <br /> PROPOSED USE OF BUILDING:home <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): ❑New,Construction ❑Addition ❑✓Remodel ❑Repair ❑T.1. ❑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:supplemental plans showing finished basement <br /> attached to current permit B2311-067 <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 1 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 /> 1 PERMIT# <br /> City of Everett Official Use Only <br /> /Ili'' PERMIT <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />