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umm 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 /U I 7 5 f l- <f E PARCEL#: <br /> CITY 6"ve j e STATE W.'�" ZIP 1 Zo3 <br /> SUITE/UNIT#: L„� K . 5 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): '((1 t �3Z <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: INf I/14ten-S <br /> OWNER MAILING ADDRESS: STREET <br /> CITY Sl AI L ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: IitJY j� �� Lp,15�Ve {t WA STATE CONTRACTOR LICENSE#(REQUIRED):projcv Z 5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 47 707 <br /> CONTRACTOR ADDRESS: STREET 2`'f/?j L 5 IGt _ 7 <br /> C`TYITY�S'i k0/>+r°jl "/ STATE Gal,/4- ZIP l ca cZD <br /> CONTRACTOR PHONE: ``(Z b / T.--C: Z.$ ) CONTRACTOR EMAIL: i ULJGLLL—OSO 6 O(i Mc ,'[,0 G4"1„ <br /> PRIMARY CONTACT: 0 OWNER Ki CONTRACTOR ❑OTHER(Please Specify) , { <br /> CONTACT NAME: CONTACT PHONE: CIL5.. 77-O LSo <br /> O <br /> , iCG1C¢ L Nry_ CONTACT EMAIL: tAij,�I�LLCdSO6 6LrvlClt <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ Lf(J,000, 0)0 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: LC(l/'! 1w"i; f 1��S <br /> . <br /> PROPOSED USE OF BUILDING: �t f�t, '(rwlj f /y ( s, 4' <br /> HEAT SOURCE: ❑Gas EIElectric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ZMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition 1Remodel ❑Repair ❑T.l. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> LiFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above group ❑Other: <br /> DESCRIPTION OF WORK: akLuXc-A friv„,k; Y W, <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 /> P IT <br /> Owner/Authorized Age ignature Date (Revised 2/8/2021) <br />