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• <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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET up (2 =-e)z 42 PARCEL#: <br /> CITY 41)99 (( STATE W4 ZIP L�3 <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: ., o p <br /> OWNER MAILING ADDRESS: STREET 41i9Z.6 l -a.Ax.A( eL A2 <br /> CITY v V-� �� STATE W ZIPe-C <br /> OWNER PHONE:T 66— g1 — � �z OWNER EMAIL: .' t',4 r,.).1 Qt l c� ,Q� Q L -G <br /> CONTRACTOR COMPANY NAME: V�� V `' yr <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ;CI-OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: &6—V 1` — 6-)98 //////������ <br /> 1/`r •QJ i � CONTACT EMAIL: //� ^J , �' .a/v <br /> /d�/�Q <br /> ILDING INFORMATION <br /> VALUATION OF WOR :$ L (, „1 . L\) ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the pre iling fair market vlue of all labor,materials nd equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: IS$FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-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 OTank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> ^^ c <br /> eGlitc-t <br /> Ccc _ )tick" <br /> SF <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 i <br /> O#OpyO�?� PERMIT# _ /� <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) V <br /> pccepr--RW 22 UO Off, 0 <br />