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• <br /> BUILDING PERMIT APPLICATION <br /> EVERETT <br /> CITY OF EVERETT PERMIT SERVICES <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((E)everetteps@everettwa.gov((W)everettwa.gov/permits <br /> Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: sTREET CJ 10 6- '115gral zS-1 PARCEL#: <br /> CHY o-Arrt STATE 4' ZIP !(/vV 3 <br /> SUITE/UNIT#: FLOOR#: f ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: <br /> ' Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t <br /> OWNER MAILING ADDRESS: STREET 73(0 //- �./ S'7 <br /> ern'-1 J Z7 ( STATE 2 �( <br /> OWNER PHONE: Ste- If(0 16 9 7 'OWNER EMAIL: �ka by J ��1 y �J ('IP dJ <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): /t/ 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,v/4__ <br /> CONTRACTOR ADDRESS: STREET L f t),44 <br /> clTv � <br /> STATE ZIP <br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL: k2h2,17frlitt 2/y61,14.44.(owl <br /> PRIMARY CONTACT:7OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: so- <br /> CONTACT EMAIL: s �� <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ ROth <br /> or (ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall Include the prevailing fair market value of all ,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: J � <br /> HEAT SOURCE: ❑Gas Aectric DOther <br /> BUILDING TYPE4R ❑Townhouse []Duplex DADU ❑Multi-Family-#Units: DCommercial [(Accessory Structure <br /> TYPE OF PROJECT(check all that apply): (]New Construction [(Addition KRemodel [(Repair DT.I. OChange of Use <br /> [(Modular [(Portable [(Re-roof [(Exterior Alteration OTank(above ground) [(Accessory Structure <br /> DFence over 7ft high DRackStorage ElPool/Hot Tub DTank(above ground) [(Other:AY29 /-1 lvl w/,'N fP�DESCRIPTION OF WORK: <br /> WO /A)4 ,� � w,� & y€ &y -7 Xr/S7l, lgpu <br /> ,Vt1 9 "70 'J G✓4-UeS Ct/u7 �/t�i10 z �yZ— <br /> NA (®4 ACP Mirigodfi <br /> ACKNOWLEDGEMENT:l 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 /> I PERMIT# 061 <br /> )wner onze ignature Date R <br /> ( ewsed 2/8/2029) �� <br />