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BODING PERMIT APPLICATA/14 <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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET ICa0 /ikoft(be.. Ate PARCEL#: Qb$-LISOCDal° 1100 <br /> cm( E ms '. STATE A ZIP 'S ao3 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: I L 4- 1,2.. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (-,&t- ee— Coakt <br /> OWNER MAILING ADDRESS: STREET Iqtap M. <br /> CfY Eutrr STATE ZIP at <br /> g(SC> <br /> OWNER PHONE: (112$) 1I4 6 -19Iv OWNER EMAIL: dmAs C ocAki ir,!5 We%Ca t\.C,oM <br /> CONTRACTOR COMPANY NAME: Otayvo t;— <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: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (US) 446 -1 1I 0 <br /> eat\SOY' coGklk.c. CONTACT EMAIL: Cli,‘,6s Cocw,v1g f4 elmr,04 .czyb,‘ <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ S"Q rr®00 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair m9rket value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: jV°R. <br /> PROPOSED USE OF BUILDING:cFR aWQ.,»v\5 <br /> HEAT SOURCE: ❑Gas IGJElectric ❑Other <br /> BUILDING TYPE: NSFR ❑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 ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> \ntot" `Itrnoae,\ `vAdvern.,) cca occ4Ion o nntom \otarco(h, u A2A47. roow\, CLoS-c.-E- <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 /> r•J ( PERMIT# <br /> Owner thori d gent Signat e Date (Revised 2/8/2021) <br />