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ix BLIODING PERMIT APPLICATON <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 /> NASH I NGTON 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 l(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 9815 Holly Drive PARCEL#: 00754000110200 <br /> CITY Everett STATE WA zIP 98204 <br /> SUITE/UNIT#: A102 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME (if non-residential):Charlene and Apryl Johnson <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:AmOr Restoration, LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):6045551 81 4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Processing <br /> CONTRACTOR ADDRESS: STREET18915 142nd Ave NE, Suite 140a <br /> CITY Woodinville STATE WA ZIP 98072 <br /> CONTRACTOR PHONE:206-669-9692 CONTRACTOR EMAIL:Sarah@ amorrestoration.COm <br /> PRIMARY CONTACT: 0 OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-669-9692 <br /> Sarah Kennedy CONTACTEMAIL:sarah@amorrestoration.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $60,000 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:COndO <br /> PROPOSED USE OF BUILDING:COndo <br /> HEAT SOURCE: Gas ❑Electric ❑Other <br /> BUILDING TYPE: ESFR ❑Townhouse ❑Duplex ❑ADU ✓lMulti-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 ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Repair walls, flooring and cabinets from a fire. <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 /> PERMIT# <br /> Owne uthorized Agr t Signatures ' Dale (Revised 2/8/2021) <br /> •J <br />