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• • <br /> NMI <br /> BUILDING PERMIT APPLICATION <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 7(( 75+k 3-f- S E PARCEL#: n �( <br /> CITY t:�V M <br /> eYC++ STATE - ZIP ¶U ZO3 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0 r IIrO Ir vc- -6104s <br /> OWNER MAILING ADDRESS: STREET 2.5 17 Cal bit Ave- <br /> ., l/cry STATE (,)k ZIP R O Z0( <br /> OWNER PHONE: / N. OWNER EMAIL: <br /> Cy <br /> CONTRACTOR COMPANY NAME: /..)1e 'W -} (o t.S4Y e.TLrc /( C_ <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):W r/i Hc$3ZK5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 2 7 G'1 <br /> CONTRACTOR ADDRESS: STREET Z...(1(3,? z `k.t- I c csr,f Neck <br /> CITY ,4Dtet urt irs STATE ("j,i- ZIP `l 1(Z <br /> CONTRACTOR PHONE: j2.S- V7 7 _.O is Q CONTRACTOR EMAIL: (A)UG LLCO50 4414((, COP t <br /> PRIMARY CONTACT: ❑OWNER IK CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: Li z5- S'?7 -n is <br /> ice!'Goa e/ (�/Y! �� CONTACT EMAIL: W(4.)C LL C OSp6 9 6olar[, COS <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 5o, o(,20.Lk) 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: Inuit fa"; � IMPS isdeni <br /> PROPOSED USE OF BUILDING: jVh4 <br /> HEAT SOURCE: ❑Gas (Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU IL^FMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ETA. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: 13 6(.E ( �7 )� z i 3/ zit" l-Z L, 123 <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 1 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 /> Z-Z5--z2 P 222-0S -O( <br /> Owner/Authorized Agent ignature Date (Revised 2/8/2021) <br />