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BOLDING PERMIT APPLICATMN <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETTSUBMITTAL 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)everetteps@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION y� <br /> PROJECT SITE ADDRESS: STREET2. S ( 2 K er2- e- PARCEL#: V0'311 to 700 2J 1 �0 0 <br /> CITY (�. U c(, Q T 1 STATE f ZIP (/ e W <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): (/ S ( S ) 5 kk-)S r,,(or.) 5 t i-e_etior-+l.)) <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision:E(J{�j}t 1' e) 1 Lot No.:Z'T- Z� (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 6--.6Vc f-i+JC) j(Lc)'` n- 1 �S <br /> OWNER MAILING ADDRESS: STREET le <br /> /, I I"lJ(' ?.�L �`f�-�-0� b✓(J t-� <br /> CY �(,)_/ (STATE W) ZIP V 7v f <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: r` (2-4/61 C4 S <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED) frit kV;(✓L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): q v 7 1 <br /> CONTRACTOR ADDRESS: STREET 5w 0 t � I l0 d/ <br /> CITY tJ STATE J A' ZIP V 05 7 <br /> CONTRACTOR PHONE: 4 25 - 167-605e) CONTRACTOR EMAIL: ry)►4-t) , C-6/ - <br /> PRIMARY CONTACT: ❑ OWNER *CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ,CONTACT PHONE: L4 �--5 2_ D 7 — Q 05 6 <br /> I 0- I ) 43 ylw OLS\ CONTACT EMAIL: pe" yv �Z- Y vt�• C.�1^� <br /> 1�v 00 BUILDING INFORMATION <br /> VALUATION OF WORK: $ 7 3 0 ' ASSOCIATED LAND USE PROJECT#(if applicable): ,. d/ <br /> (Valuation shall include the prevailing fair mark6t value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: w {/O1)5€_ <br /> PROPOSED USE OF BUILDING: Ll..)A U-CO S e- I C4— 54-13" - <br /> HEAT SOURCE: *,as ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> TYPE OF PROJECT (check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair /1T.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: 6�^ yJ1 J 5� �t coo- 61n� 0 F <br /> 1 _s 1 C.- c (CA) ) +t S� 54- i •-1 -ems ��� <br /> ,PlIA T l lokv./.0 SI" e.Qk, r t,tJ e.,J-r` c� <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 Use Only <br /> h(V1 %1/4 141 itilt4bejL-3 tj—C.— 3124 taps -024 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />