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III III 8:55 PM Mon Jul 10 c 83%ice 1, everettwa.gov vim 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. 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 I(E)PermitServices@everettwa.gov I(W)everettwa.govlpermits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 'D.;050 I\ VAC' �J� PARCEL#: CITY ✓W2r.P.`/�1��"+� STATE LrOa.. ZIP g6ao1 SUITE/UNIT#: \ FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plai subdivision: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 1.20 J- \r(LS � �g - OWNER MAILING ADDRESS: STREET eLD 3O i�'Cit Icv' Ci (,ek STATE Wa.. . zip l V az, 1 OWNER PHONE: L 9 - 1 a O s 1 OWNER EMAIL: (Kar Lr 1 a lam( mo... U.s-1- n EA-- CONTRACTOR COMPANY NAME: c3-eA 61 ba., 5 W Div WA STATE CONTRACTOR LICENSE#(REQUIRED):5-64716fidit CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 t/ LiC 3 CONTRACTOR ADDRESS: STREET pP,(OD 1 lem S•f Sty .TT /// [✓��/ CITY L v�A/�u00P, STATE �/¢ Z''` ezL!/ CONTRACTOR PHONE: }e-- 9 )�,—,.).J CONTRACTOR EMAIL: .SQ,c7�ti!.. 4N,(1,.A,i1i: ,j • �%6-•fti.. PRIMARY CONTACT: 4-QWNER ❑CONTRACTOR .OTHER(Please Specify) __ CONTACT NAMEj: , 1 CONTACT PHONE: r�an�- ct a -�Dli/�g� �I/�/� n /� Ro /vl I�o.� CONTACT EMAIL: 1 IA of L a(6/ liV t I tf ' 4• Y 1,QA-" BUILDING INFORMATION VALUATION OF WORK:$ I i 5' tO ASSOCIATED LAND USE PROJECT#(if applicable): �(vat Ler-sl i s':,de'. e prevailing fait m rket value of all tabor,materials,and equipment needed to complete the work.whether actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: _;Gas LJElectnc ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: E Commercial DAccessory Structure TYPE OF PROJECT(check al/that apply): ❑New Construction L_Addition El Remodel ❑Repair ❑T.1. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration DTank(above ground) ❑Accessory Structure � �RJ rr^ ❑Fence over 7ft high -RackStorage ❑Pool/Hot Tub ❑Tank(above ground) Other. ID ne)r ,4r�w`v t G- L. DESCRIPTION OF WORK: 0 7 5•' Aot\Ne 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 the Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made. and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. r�----"'� City of Everett Official Use Only fr �/ �'�� If sa L( J r' 1 PERMIT f 3 V t- - 00. . Owner/Authoriz Agent Signature Date (Revised 4/21/2022)