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• � <br /> BUILDING PERMIT APPLICATION <br /> mai <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 70 75t 5- 3 e/ PARCEL#: <br /> CITY fve cef-+- STATE ZIP ifZo3 <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;Ir;c1 Inve-(54-nl0 s <br /> OWNER MAILING ADDRESS: STREET 25 / 7 Colby Ave. <br /> CITY SLATE (,) ZIP If 0 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: 0r4-114-Uf- Co, yel.Cho _ <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):W fI HC_t 32KCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 2 70 q <br /> CONTRACTOR ADDRESS: STREET Z`/(3 z S wee_ Roes,:"' ''4X <br /> CITY LeoGIo frn STATE W 1- ZIP (O L 4 o <br /> CONTRACTOR PHONE: ((ZS- T57 7 -Q 2S 0 CONTRACTOR EMAIL: W(4)L LL G OSO C 9 401G;I, COPtt <br /> PRIMARY CONTACT: ❑OWNER k CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: // / / CONTACT PHONE: KZS_ �? 7 _0460 <br /> �i G t /e/ Gt/YI 9, CONTACT EMAIL: (A)4./C L,L�OSO6 19 6mak. / cokn <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ ZCU, 00 b. t-,ty 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: rl,(A.it 6"; � RPS r01en-4— <br /> PROPOSED USE OF BUILDING: In'jLi (' D'ki•-ttdm RG-S;cee 1 'y <br /> HEAT SOURCE: ❑Gas VElectric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex -#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel LiRepair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable LIRe-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: `)e oC 7 2 2- 7 ZS <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 /> PER # <br /> -25_ZZ so Z2©3 --6\ lQ <br /> Owner/Authorized Agent ignature Date (Revised 2/8/2021) <br />