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no BOLDING PERMIT AP LIO N <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> wnsHlrvcroh 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)PermitServices@everettwa.gov I (W)everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET• 13 0 .,3,4 0A D j j y PARCEL#: <br /> gCITY / �i i STATE (.,)4 ZIP 9 e 2,0 I <br /> SUITE/UNIT II: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): 80 06(. -pq 0 At Jere°-9 cvaq r/ <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 13 /Ah( P,R <br /> OWNER MAILING ADDRESS: STREET /y} 3'"p0 C011 ie/j P 7 <br /> CITY ,9R yJ V 1 L�.. "' STATE ��-e9 ZIP J C l 2/'1 <br /> OWNER PHONE: 4 2 ' )2 - 8 d g OWNER EMAIL: gG x 1,14 g.,K, ea 4 mg i L, <br /> CONTRACTOR COMPANY NAME: c Ne.<(Y (� ),41A14 pr c f(J-7- S 8 gi'I LE S <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): <(k �N�f�tr rye S `?CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): `9"go 00 <br /> CONTRACTOR ADDRESS: STREET /(s(}2 L (70-rti. A J e <br /> CITY t,,� D Is i`4F(J f STATE zIP 17,0 <br /> CONTRACTOR PHONE: +-{ -5 -,2,,.0 )'3 - 3 co CONTRACTOR EMAIL: CIYI S yy/s L)/4' , Corte <br /> PRIMARY CONTACT: grOWNER El CONTRACTOR Ll OTHER (Please Specify) <br /> CONTACT NAME: M--AM7109 CONTACT PHONE: r a y r^t I 8o Co <br /> 6g J , tV pgR.K., CONTACT EMAIL: K doivej< --x24 lL , <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ LOCI JL'G 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: g e 09 / ('? -j/ 4,ivvc-A.)i C .tip e C ) <br /> PROPOSED USE OF BUILDING: ke 7p/L.. 4 C c,GEk y JIG.'t E J <br /> HEAT SOURCE: t_7Gas AElectric (.,Other <br /> BUILDING TYPE: [SFR L]Townhouse [(Duplex TADU (Multi-Family-#Units: lKICommercial ElAccessory Structure <br /> TYPE OF PROJECT(Check all that apply): E]New Construction LAddition ❑Remodel ❑Repair .I. LiChange of Use <br /> Modular ,__1Portable (._lRe-roof L-lExterior Alteration (Tank(above ground) ❑Accessory Structure <br /> Fence over 7ft high L-1RackStorage LPool/Hot Tub ❑Tank(above ground) L'Other:__,______.__.__._ <br /> DESCRIPTION OF WORK: ®D <br /> 6-7 C O AT r rem c To 2 ZAi FO 12/9'7,5* T/o <br /> g--2,31/ — 010. <br /> ACKNOWLEDGEMENT:1 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 l 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 /> PERMIT t _ <br /> V/8l '04 sDl ( I D ( <br /> Owner/Authorized Agent Signature Date {Revised 4l21/2022) <br />