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mow <br /> 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 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET Ica( 75' & 5-1- 3 E� PARCEL#: <br /> CITY FVeYe STATE I/V!'P- ZIP if Z.O3 <br /> SUITE/UNIT#: FLOOR#: 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: 0; iliao4L5 I1vC-641netrEs <br /> OWNER MAILING ADDRESS: STREET ZS 17 COI6y_ <br /> CITY 6-V cry L I-r STATE („J,t-- ZIP I v 20( <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: (/,J,''l(yrU../ CoptS'fra,61-;cteLLl WA STATE CONTRACTOR LICENSE#(REQUIRED):w l' HGg,32K5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 2 /-7 <br /> (2' <br /> CONTRACTOR ADDRESS: STREET Z l (32._ S 14 Roes;.tQ-c y,ck <br /> .CITY ejti �/�j d STATE wii- ZIP gg <br /> zr(0 <br /> ((2 <br /> CONTRACTOR PHONE: S— T57 7 —Q 13 0 CONTRACTOR EMAIL: .JC)C—LLGOSO 6 194414;I, cont <br /> PRIMARY CONTACT: ❑OWNER iJ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT7y�� NAME: / // CONTACT PHONE: ( 5_ 27 _ Z550 <br /> 07,cA e/ Ll/rf` KI- CONTACT EMAIL: W WC L.LC_OSp6 6/416 /. e(ji <br /> B ING INFORMATION <br /> VALUATION OF WOR •$ Q SOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailin ,materials,ands ment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: ri,(A.If/ f 4..t � ReS en.� <br /> PROPOSED USE OF BUILDING: Mu (I k i./ 11,5; ei <br /> HEAT SOURCE: ❑Gas [Etlectric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse Duplex ❑ADU ®lvlulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ENew Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑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: <br /> iRe ( I1S, ( ZI, ► 2z <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 User Only <br /> 2 Z 5-- ZZ - PERAS# <br /> Owner/Authorized Agent Ignature Date (Revised 2/8/2021) <br /> )1/2_ <br />