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BUILDING PERMIT APPLICATION <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 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET <br /> II (AAA Y 4111' t� )110 L-i-t't,, PARCEL#: <br /> CITY 11 <br /> CITY CIfiv STATE \I✓(1 ZIP 'IV:261 <br /> SUITE/UNIT#: FLOOR#: („7 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 /> OWNER MAILING ADDRESS: STREET II <br /> CITY �� STATE t,UA ZIP CI {U) <br /> OWNER PHONE: OWNER EMAIL: ,t IC p • ;�, C�,,. <br /> CONTRACTOR COMPANY NAME: �` LL �u.,. E't ht ,/ i <br /> "" <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): M I I �.t Owl)Q}) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> G(' <br /> CITY `(�')� STATE `�'� ZIP <br /> CONTRACTOR PHONE: �' CONTRACTOR EMAIL: -{ q IY� 6(, <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: _ \' CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 2t70U 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 /> ►1 <br /> EXISTING USE OF BUILDING: 112 <br /> PROPOSED USE OF BUILDING: ,\ 11 <br /> HEAT SOURCE: ❑Gas 14Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ( ')07 ❑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: I <br /> m -oolb <br /> ACKNOWLEDGEMENT:1 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# 6�05-bcq <br /> Owner/ ut orized Agent Signature Date (Revised 412112022) <br />