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BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET S. /`F V.� PARCEL M CITY EvG r� STATE O D� SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable/ TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat subdivision: Lot No.: tach copy of long legal description) CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET ,50 /`fL✓r, c lTy C V e-✓t;f-f- STA W�� ZIP OWNER PHONE: ZS-_ 4A,26 - 9 37fr-3 OWNER EMAIL: CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY O EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY - STATE ZIP CONTRACTOR PHONE: CONTR TOR EMAIL: PRIMARY CONTACT: XPWNER ❑CONTRACTOR ❑OTHER/(Please Specify) CONTACT NAME: >> f CONTACT PHONE: —27 ;231 /CONTACT EMAIL: (��l f /`S-15, tal,0S7'v ut e /CId,,,�A C'a 11VILDING INFORMATION VALUATION OF WOR : $ ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the pre iling fair market value of all labor,mal9ji'afg,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDIN PROPOSED USE OF BUILDING: rY 5/d -1- HEAT SOURCE: ❑Gas Electric the VC BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ulti-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that appl : ❑New Construction ❑Addition 'KRemodei ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roo ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure / ❑Fence over 7ft high ❑Racks rage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: �� rO�r� v'��a r !"t!`� baT(7✓yd' DESCRIPTION OF WORK: 011ie � rfs�-rN 1�Jas�G'✓!�l/I7` (/'(�D��'[ lH�7� o bC17'�jl!/�U vt. v nfirm he information contained herein is true and correct. Work done ursuant to this rmit must comply with ACKNOWLEDGEMENT.' have reviewed this application and co t P permit_ ,. local w. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the current federal,state,and oc a g g p y pp Building Official before being authorized under any circumstance./am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 202 Owner/Afithorized Agent Signature Date (Revised 412112022)