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r S 411 • az BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVE R E T T SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Ble or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 3l l�Ir 1 w PARCEL#: 00//70 1 /) CITY ,v STATE WA- ZIP �// SUITE/UNIT#: FLOOR#: 05}ti1 TADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACTnn INFORMATION OWNER NAME: ,moo}, R ► r d-i lit/,_ (_�'1, .-C o k1 OWNER MAILING ADDR S: STREET / /7 3 ,6Jx .mac_ CfrY STATE `(O 771— ZIP )S i/-Y/ l OWNER PHONE:7Q 370 -IVV/0Pll r '1 .� [►�f OWNER EMAIL: � P v 11,�L//00 >6 e. 1',t CONTRACTOR COMPANY NAME: 6 l4/1 ,I/ 9-0),--§,_ sl �( t CP �'1WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERE BUSINESS LICENSE#(REQUIRED): AM-- CONTRACTOR ADDRESS: STREET / 3/'('/!' „II-thy �! I / /� /f� CITY STATE 'Ve 1,7 ZIP q 1 C„rl(Jl CONTRACTOR PHONE:2.06 -'` 7 Q v -D // CONTRACTOR EMAIL: Y.-Qrj A A 1 e,t I/- Ili k "' 0 PRIMARY CONTACT: %OWNER 0 CONTRACTOR ❑OTHER(Please Specify) 0 /� /' CONT T NAME: / CONTACT PHONE: 2D ea 3' 7 —v /ell` /, �� v`�C -,dam-mil_ CONTACT EMAIL: ye yt (+ .22u C 1�� (d/ a t-o�e A- "u OIY' ✓ BUILDING INFORMATI , VALUATION OF WORK: $ 60 0 . ASSOCIATED LAND USE PROJECT#(if a 1:1-EcEll�� (Valuation shall include the prevailinglIrmarket value of all labor,materials,and equipment needed to complete the work,whether actually poi. \\ )c` EXISTING USE OF BUILDING: . r JUN 0 3 202L; E!I PROPOSED USE OF BUILDING: _ HEAT SOURCE: I, 'Gas [Electric ❑Other BUILDING TYPE4SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commer� e e1tQF s stEoF P EE rsel T TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel tepair DT.I. ❑Change of Use 0 Modular ❑Portable El Re-roof 0 Exterior Alteration ❑Tank(above ground) DAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) DOther: DESCRIPTION OF WORK: Ii#1-et.oft_ -eAA-51-1144 ryttivvi 1, /9-0-SeA40-iL-* Kalikt --144_pd- kraLf P-1714e-d-' J-K-24-4-4-1 11\11/ r Yt -o .1-- mil e_d rt2..+4r `e iz-aD yet, atiq- t-di/ 0 S ► 1 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only /. i PERMIT# �./111-44.-' /1..Nt1(5--)A 20i/ ��-003 9 Ow utho ' ed Agent Si nature ate (Revised 4/21/2022)