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BUILDING PERMIT APPLICATION IdStreet ECIE V E CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements ¢f c,opi�s J.Vij-h forWASHINGTON then drop off completed application plus all required submittal documents to 3200 2nd Floor Intake Dro CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W) ! R E T (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Pprmot Services PROJECT SITE ADDRESS: STREET ej 2 O (+iJ Q r(� C� PARCEL#: CITY e Y P STATE ZIP SUITEIUNIT#: FLOOR#: ADDITIONAL 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) CONTACT INFORMATION OWNER NAME: C I' U IIPk C--iJ OWNER MAILING ADDRESS: STREET CnY STATE ZIP OWNER PHONE: y'L - .2 2 - E' OWNER EMAIL: CONTRACTOR COMPANY NAME: U t/v (✓G d WA STATE CONTRACTOR LICENSE#(REQUIRED):j KL (0' C, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 8 Q CONTRACTOR ADDRESS: STREET 51) G' G L ,� CRY PtFT o�<SNy3TATE CONTRACTOR PHONE: SVq 5`7 / CONTRACTOR EMAIL: R0 f t S� 6— PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: t p S( 2 Sew V Ice- u,`l / YC� CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK:$ 1 2 v- �/ ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall Include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: []Gas ❑Electric ❑Other BUILDING TYPE: FR []Townhouse []Duplex ❑ADU ❑Multi-Family-#Units: []Commercial ❑Accessory Structure TYPE OF PROJ CT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. []Change of Use []Modular ❑Portable,�i�te-,roof ❑Exterior Alteration []Tank(above ground) []Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: Re Roo C,,n� (Nort�—' ACKNOWLEDGEMENT:l 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 locallaw.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only r�77 PERMIT# ((// Owner/Authorized Agent Signature Date (Revised 412112022)