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Imo <br /> BUDDING PERMIT APPLICATIar <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 I(E)PermitServices@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 11 O l rfanktl;f,w `/A PARCEL#: OO '6-O0 P-OO <br /> CITY E't/enr-c,tk STATE tAfA ZIP 18n3 <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: D tcM\t. -1- Nil Col ottivvvt <br /> OWNER MAILING ADDRESS: STREET SJ, G, Q(Q,Lk pIA ,C,S <br /> CITY STATE ZIP <br /> OWNER PHONE: 1-7-5 .tk$t -$t j a OWNER EMAIL: Ctianf., c, v'-t . c-oU at—pLv-. GuAA._ <br /> CONTRACTOR COMPANY NAME: Sow+ t.A.Z RisA ,G ( RAA.i,VOLii0 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):5 R.SgQf6.7. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 09 q <br /> CONTRACTOR ADDRESS: STREET I Lt Cl /U (Gels.el S+, S+ - (p' <br /> CITY McV\Cert. STATE (A)21 ZIP qg nej-- <br /> CONTRACTOR PHONE: ya5--43( - O I CONTRACTOR EMAIL: 12usctu@ Sylow-iiMt.k M- fc�o,��fia�n. CWtti <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ]OTHER(Please Specify) iteSriTeWit( <br /> CONTACT NAME: CONTACT PHONE: Lt'}f l ii g/ - g'( 16 <br /> St�Piri al CONTACT EMAIL: 5e(e.,,,t a p,� �''�- {�•e5i 5/�l COv1,�np�,H,`� , Go,� <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ Cb0. 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: ,i(\t3r(2 .(AMvt:Iv( 'rCyaidenCt �" <br /> PROPOSED USE OF BUILDING: Si/1(e ..1.i iv.;L;Li re tFivu,t W/ ADU dowf't,st - r <br /> HEAT SOURCE: 1�IGas ❑Electric UU ❑Other <br /> BUILDING TYPE: KSFR ❑Townhouse ❑Duplex "ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction Addition XRemodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ElFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> MM-M-or►Gr f-e r O QL4 i 6 aS 2rn k At O CO.Akpe„r5: , GU4 O( <br /> aotcti- 'ova- cor 19.1&tor✓a,4'ova, a4 sue.i - S . <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 Con actors Law 18.27 RCW and 296.200A WAC. <br /> /� j� City of Everett// Official Use Only <br /> I oil �(/ PERMIT# n�a! ( — CJ o q <br /> Owner/Authorized Ag nt Signature l/ to (Revised 4/21/2022)( <br />