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ism <br /> mi B DING PERMIT APPLICATIRI <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 390 5 flo.4 efe I(tr 4V4 it 3 PARCEL#: 10it 00 f'l.3 &l 66L 1O2 00 <br /> cm" � 14 STATE Val hi, ZIP 62 ) <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): -- <br /> TENANT/BUSINESS NAME(if non-residential): J 1'i 0 5 .d e.K E F t L.L_E:12 L L L <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONT INFORMATION <br /> OWNER NAME: 3Ejp� I pp oc.ttte 1 ((et- G.L.0 <br /> OWNER MAILING ADDRESS: /STREET <br /> /^ c/0 j /0"1 44' 5fi 5r <br /> CITY ` y �LFj hi STATE r yiv, ZIP 9 2a <br /> OWNER PHONE: 6 - 3(9 !Cc cc ) OWNER EMAIL: /yI*k 6r4;/-Cc' <br /> CONTRACTOR COMPANY NAME: Mesa Cv 5-11vC'Ira» 41-1 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):NFL 61 CG.L*WO CITY OF EVERETT BUSINESS LICENSE#(REQ IRED):CZ966 <br /> CONTRACTOR ADDRESS: STREET /041 tots i" 54- 5 L. <br /> CITY t VeC'f-f STATE („1tt4t1 ." ZIP In6Y, <br /> CONTRACTOR PHONE: 1lzc-aj jq- 64 5- CONTRACTOR EMAIL: '15)jrk 6,51.„42/,tQsy, <br /> PRIMARY CONTACT: IST WNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: J.J CONTACT PHONE: {Z 5, 3(q.- 6:5-6 — <br /> J IGri-et9 y^ CONTACT EMAIL: /SA 67,14,.f 0,,t„ ,,,.... <br /> BUILDING INFORMATION <br /> o <br /> VALUATION OF WORK:$1 07000""" ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market valueI of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: flGSrpCdr/frci/ 5ra k fcrn//, tae V"t R L. <br /> PROPOSED USE OF BUILDING: , C5ichel Act r 5tvt ( '�r� t Q-�NT A-L <br /> HEAT SOURCE: 12'l;as lectric ❑Other J <br /> BUILDING TYPE: 06R ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition emodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration [Rank(above ground) ❑Accessory Structure //� // / <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other:(,/�e/n de I 77a'/[roe_ T icoiG <br /> DESCRIPTION OF WORK: / <br /> — RQ i0 - si c <br /> — maik, L.Q, e r L. Q -e-v-` if <br /> 'k;j of .,, Lam c9 0 ti►,- w-ciU- et .21-ctee - 3 Z <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 /> WR 1 1 8 12.e 2I Pccllko.„ p s <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />