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E <br /> BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <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 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 70( 7 5* 5+ 5 E PARCEL#: <br /> CITY (�VeYe++ STATE W/'P- ZIP ZD3 <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: I I!Q✓&5 InvCisa-rnerrts <br /> OWNER MAILING ADDRESS: STREET 25 / 7 Cot by- AVG <br /> CITY C 'CN G4 STATE WA— ZIP Cric`O <br /> OWNER PHONE: ( OWNER EMAIL:L <br /> CONTRACTOR COMPANY NAME: (JItgt.te"WO- COr�t,S7'YGCGTfolt1 <br /> W // L <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): y(4FfG$32K5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 2 70' <br /> CONTRACTOR ADDRESS: STREET Z /1 i3� /S `4 ► oes 4 r�e_, �/ <br /> CITY QYI oK'1;t5 k STATE W� ZIP qO z'L C/ <br /> CONTRACTOR PHONE: KZS- '7 7 'O ZS Q CONTRACTOR EMAIL: (,J(4)G L C OS°G P 4/14;I, COnt <br /> PRIMARY CONTACT: ❑OWNER IIJ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NA/ME: / / CONTACT PHONE: YZS_ E'T7 -also <br /> 07 Ghae/ G/Y!�N CONTACT EMAIL: (A)(JCL.Lc_Osp6 ® /'e [, CokYi <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 7 Cj,0( i2,v0 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: m(A,'f( 1G,.� ! _ RES t)er <br /> PROPOSED USE OF BUILDING: Wl(A (1-I �41"11iI RL-SrGee <br /> HEAT SOURCE: ❑Gas (Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ®fvlulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑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: <br /> el <br /> eiioCLA 5i 3 531 <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 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 /> Z -Zs - zz Z2n3—p\,5 <br /> Owner/Authorized Agent Ignature Date (Revised 2/8/2(11)0 <br /> Pi <br /> 11 /Z <br />