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• <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 70 75. . S-j- 5 E PARCEL#: <br /> CITY (eve-c e 1y+ STATE ZIP if Z o3 <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 /> 1 1 /CONTACT INFORMATION <br /> OWNER NAME: W 1 11601.5 �►1v�'�-►'Ker14S <br /> OWNER MAILING ADDRESS: STREET 25 l 7 Colby.- Ave <br /> , <br /> CITY 6-I/L Y STATE wA ZIP iv`o <br /> OWNER PHONE: / L OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: G../Yt IJ(: -^Ce5AS4-YctcLL rGY2Li <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):w ,L�Hc$32Ks CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 2 7 rj Y <br /> CONTRACTOR ADDRESS: STREET Z`/[3z S wet_ Roes �/ <br /> CITY Syl,p�/t o(tt i�3 s STATE (Aid- ZIP g p Z q 0 <br /> CONTRACTOR PHONE: (4ZS- 8 7 7 _O l3 Q CONTRACTOR EMAIL: (A)VC—LL tG 050 6 G Ma I Y, COn <br /> PRIMARY CONTACT: ❑OWNER ik CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: // CONTACT PHONE: C 15_ ?7 _0 ZSo <br /> i7.GAl e/ Gt/Y CONTACT EMAIL: (A)64)C LLC-Osc V 6/'Ar 1, G°kr/ <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $ 5(),tt 00, G,ti 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: r'1,(A.1+-i fff(,�r ; � Res rce <br /> PROPOSED USE OF BUILDING: I''lu ��I D'�i i"tl i/„ Res r de.t <br /> HEAT SOURCE: ❑Gas IIlectric ❑Other <br /> BUILDING TYPE: ESFR ❑Townhouse ElDuplex EADU WWulti-Family-#Units: ❑Commercial EAccessory 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 /> Rt' 0de �/3, lgVl V7 Li, ss32,1-33 <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 /> Owner/Authorized Agent Ignature Date (Revised 2/8/2021) <br /> t�2t0°I .4CA I� <br />