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4 <br /> MIMI <br /> • <br /> BUILDING PERMIT APPLICATIi4- 4i1") <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 46 0.1 elitist twit • PARCEL#: <br /> CITY /5././12,Q Y'STATE A- ZIP `, yO I <br /> SUITE/UNIT#: FLOOR#: l:-V 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: <br /> AA-PAN T/dYt ,1.) VI C—Pk) 6 .Ge c S <br /> OWNER MAILING ADDRESS: STREET /7.4 V_C--- -C ,41:0 C/I pf y V.V. PrE 41 /3 6 /�� <br /> CITY S Q--01 y-e `./STATE 1/V7 / ZIP C1P—`2j <br /> OWNER PHONE: <br /> '6 7 . . . OWNER EMAIL: /4 t <br /> tJ Z i"i(�4/A/Vi & .e G�4 / V, , <br /> CONTRACTOR COMPANY NAME: by 0 i1 f/v C 7tg , <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): / CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ,AI OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 7'D 310 9 e <br /> V j CT Q A--1/'- 6 V CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ S."6O O . 0 0 ASSOCIATED LAND USE PROJECT#(if ap licable : <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid r 0 ) CEINF"\ <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: MAY 2 2 2024 <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU 0 Multi-Family-#Units: ❑Comme IT ]GEs�;DpV1'v �t TT <br /> TYPE OF PROJECT(check al/that apply): ❑New Construction ❑Addition ['Remodel ❑Repair ❑T.I. ' i a ettr`C152ices <br /> ❑Modular ❑Portable El Re-roof ['Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> OFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: f <br /> .'re4i r) VQr -QAIS J Jh cj XA,,1 j b,es J, 00,,,f)( p lr- -- , )12ivt,,,r ,p wry /, <br /> 004 i vus+AW KAA-4 y-o-vr s A.--;L7 le , /-4-/-1-61 .,,--.,v( )/' 1,tZf-S <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 /> PERMIT# <br /> s / 12�4os 06? <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br /> 11 <br />