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BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL.INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5V 51F PARCEL M QB9 QQ 2Q 1Q0 CITY CV C�e STATE WA zIP q��q ' PS)z SUITEIUNIT M FLOOR M - ADDITIONAL LOCATION INFORMATION (if applicable): TENANTIBUSINESS NAME (if non-residential): ({C�C , - B��►er� 1.�1ve- LEGAL DESCRIPTION for new construction: Short Plat/subdivision: - Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: WC11 EoW t( Ian alc� G�I(Ov L1-C OWNER MAILING ADDRESS: STREET �}�i()o Q(C Is CITY Tote.60 011 STATE ZIP 3�I OWNER PRONE: T�l- gZ`nn6-7 I OWNER EMAIL: MI5 B we11�OWQI . CVA CONTRACTOR COMPANY NAME: UhC Zr\C, ny WA STATE CONTRACTOR LICENSE#(REQUIRED): C_C -JRQ !{ * %Li GITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 2-0166 TOM VSEn HV CITY 1 f Y.Ctlhf�e( STATE T z,p 07 3 CONTRACTOR PHONE: L K) CONTRACTOR EMAIL: CI NI e d ) tG(1CQ, CONN PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: `� /� CONTACT PHONE: j 5 - 1?2-e t,( GA � " �( e" CONTACT EMAIL: C 1nf e� la J rinc.� • c oM BUILDING]INFORMATION VALUATION OF WORK: $ � 1ASSOCIATED LAND USE PROJECT#(if applicable): N 4 (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not,) EXISTING USE OF BUILDING: 6RGor L-.Vir, PROPOSED USE OF BUILDING: 5C V`'\ 1-11f N f? HEAT SOURCE: ❑Gas ❑Electric ❑Other VIA BUILDING TYPE: ❑SFR ❑Townhouse []Duplex ❑ADU ❑Multi-Family-It Units: Commercial ❑Accessory Structure TYPE OF PROJECT(check all at apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable Re-roof []Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: A0 RQ 00gc'(\ 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 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 fire Building Official before being authorized under any circumstance.l am the owner,or f am authorized by the owner of this property to perform file work for which application is made, and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only C7 -7 -23 PERMIT# OwnerlAuthorized Agent Signature Date (Revised 412112022)