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BU•ING PERMIT APPLICATIO <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 6 5 Q/ Po(67� Pr. PARCEL#: <br /> CITY t4/�7T_ t STATE W ZIP / 2Q3 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): (4 Ff Shed C <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> / CONTACT INFORMATION <br /> OWNER NAME: 62'5O 6 p -dn{0���{�IQ� <br /> OWNER MAILING ADDRESS: STREET (,SO I c•Cf l/ie r PC I pp�� /J <br /> CITY £vr� SLATS 14 ZIP tOZo <br /> OWNER PHONE: OWNER EMAIL: TTl7 <br /> CONTRACTOR COMPANY NAME: ) t ,s hat I C <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): I t,ff-5y gQ% CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): sh-zisvir <br /> CONTRACTOR ADDRESS: STREET ` 777 S'owf-i ycfi^riico of S re-1 Scar 'C — 6oQ <br /> CITY ��6/" STATE kettio C c2 ZIP 802/0 <br /> CONTRACTOR PHONE: 6 S 7— yoZ / CONTRACTOR EMAIL: JI-ioVes Ga ( $ 17ed'. COS <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR OTHER(Please Specify) A-02/1 ca <br /> CONTACT NAME: CONTACT PHONE: 9 5_ 6$I 4'02 A_ <br /> () C®ire3 CONTACT EMAIL: l p/)`-ej- 4-6f 14.15Atori- G om <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 10,000 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: yJ,i PROPOSED USE OF BUILDING: C 1'OcS S �v CZ t uApcn'a/4se - 5ra f otacks <br /> r. <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other C <br /> BUILDING TYPE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: Comm c rtietu .s <br /> TYPE OF PROJECT(check a/I that apply): ❑New Construction ❑Addition ❑Remodel El Repair ❑T.I.`' ' Change of Use , <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ` 1 yv <br /> ❑Fence over 7ft high NRackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: 4leRET <br /> DESCRIPTION OF WORK: �O� Q It SerV"' <br /> �f'm <br /> Qac3 -Fo r Sked <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 b e eng 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 1 comply the St to Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 62. 14D ()-1 <br /> Owner/ tho i d Agent Signature Date (Revised 4/21/2022) <br />