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<br /> Erj BUILDING PERMIT APPLICATION -r3 2023
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<br /> Y T T SUBMITTAL INSTRUCTIONS:See CITY OF EVERLI I PERMIT SERVICES LiVx
<br /> applicable submittal theckitst far submittal requirements and number p+f e rP lr f revue;:;
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<br /> 'wS'A3Ni NGTON then drop off completed application plus all required submittal documents to 3200 Cedari$tie t n o rlsp'8ox:
<br /> CONTACT INFORMATION:(P)425 257-88101(E)PermitServices@everettwa.gov (W)ever+.#i+ra itr fSer'VICe
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET \['3 L-O t( e „, V60:;af. 1 PARCEL* t" ` �� � C ( 1
<br /> CIrr ".� x-j ke,-f 1 5TA1e (At,.1 an ' 7a }'',.. 1 t,,
<br /> SUITE/UNIT NAME(if non-residential):
<br /> ADDITIONAL LOCATION INFORMATION(if app(icaf�te). v \\ v,,,- tt
<br /> TENANT/BUSINESSlit p _.. , J �.• % :_ � _ »•
<br /> LEGAL DESCRIPTION for new construction: Short Plattsubdivision: tom.}/'° . Lot No.: /1/1. (attach copy of tong legal description) '''.
<br /> I � CONTACT INFORMATION
<br /> OWNER NAME: IVI O,S J AeD
<br /> OWNER MAILING ADDRESS: STREET Ct•l/j '2? �L 0'( tj PI- 1 '
<br /> CITY C,kd!t,✓ • I i STATE �1\ ZIP 2 O I
<br /> ' OWNER PHONE: c7 7 ( 3'7/` ! ~f"LL OWNER EMAIL: (.i 1 It.af.St)r)5`22G rroi 11,t-: ,ry1 , x1-„
<br /> CONTRACTOR COMPANY NAME: E 0 kiN (.., .r ti6 iA10
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<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVEREI I BUSINESS LICENSE#(REQUIRED): ''_' ,' a• A , ;
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<br /> CONTRACTOR ADDRESS: STREET /'}� "�< a�;�.�.0 �, a.a
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<br /> CITY i'i i r t STATE rV/TIZIP •z-�`.:` '.1 ; 1,
<br /> CONTRACTOR PHONE: (/ - / 7 £p:3, CONTRACTOR EMAIL: I-.n 41,MI-AVO
<br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR N.OTHER(Please Specify) 2(.:r� ",,' ^.:, ...r' �i,
<br /> CONTACT NAME: CONTACT PHONE: 'Cj '3' r
<br /> V tt` G t Ay:Kt E� CONTACT EMAIL. t.�}t C 1 6 -,`v „ ,''"l I '" ;;<Y a;+�`'
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<br /> BUILDING INFORI TION `w .1;-' N, .'''.`-/r`' •¢ ,r ,.y�T . a,
<br /> VALUATION OF WORK:$ - ' CFUSE PR* . ' ".: _ ',;; ' "'.1i''` "'
<br /> ASSOCIATED LAND ,�;,.�. �, ^'t: ..,,,� .',`.i�� '�,�'�g,�,,,«;.,�„w°
<br /> t Valuation shalt;notede The prevaEng far(mark t value of all labor,rnaterrais.and equp men t needed to compote thBAMGdf�i,,,�.;,�„}•�,,/- „ ,p td•,41W,.,.s-A.,,,,,';-', ..:',, ,,.,t ri ;„,,;; •_• =,r ',
<br /> EXISTING USE OF BUILDING: �P' '� a ., �" ter' ,' ;� r" -
<br /> # °„ m�p e ma's' 9f ',
<br /> PROPOSED USE OF BUILDING: ND0G 'boMt or) I 4t1'x 'f..00"'"�� "=Y:., ' :t 3 ' 's. ,, y `f- L'. ,
<br /> HEAT SOURCE: ❑Gas Electric L]Other '':s.•` m ,, '•` ' e>gt<> '' ; 4,
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<br /> BUILDING TYPE: SFR E]Townhouse I:Duplex DADU C]Muttt»Fatuity-1rUtiiis , s aft: `».,,.„,, .,: a i :� .„ d;;,.+� ,,
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<br /> TYPE OF PROJECT(check all that apply): CGNew Construction . Addition '.. ^ ,,,':,. t•' "�0'<;.,tt �. r ,
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<br /> CiModular LLiPortabie []Re-roof CExteriorAlteration LiTank(at ,eground ` r�r ;` �;,••.-f „• '� 4:�'
<br /> LiFenceOr
<br /> over 7ft high ❑R.ackStarage DPooi/Hot Tub ❑Tank(above ground); t®* t -", , ~,; _ ' ;4,
<br /> DESCRIPTION OF WORK:/ /,,p f '�""r �" �,! at r '>
<br /> Ir"'-7'INAA k r,) - t,o09. 1 t cr-FLO° . --^?A-f,,-t al•Dr(ifsi ( t t i�I iIY Sr ,.,#3 r�^' s,o tz r • =c..i '� zg i ,, ;A `V"fi �V;,z>,% •
<br /> H' t`^�'S."_ .! Y".+!♦-ci-'.f`-.',�:.jrv' V"51 , VI`^'1.r! & C- ' xf' ti'\e'.1✓ 1• K ."3�`'• ''• .. ', Kt„, $"}y''�aZ•
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<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information,...„-rn ..,;.--:i0,, i ;g'^q' ;..,.„.'.�" ;" ' ' ` ;;it ' .. „i ,- „
<br /> current federal,stale,and local law.The granting of a permit only authorizes approved wuNf> ,._v x,r a 't,r i,1,, V y : <,, :.
<br /> �` S' fa,ea,na .su i+k, 3 '� �E �Y.w. 1fi -4.'z£ .'SrA; v:y",.
<br /> Budding Official before being authorized under any circumstance,I am the owner,Of t ant trot ` r" _ ;r : r , .< �, Y
<br /> and I comply with the State Contract "Law 18.27 RCW and`296,200A WAG. { '"'t 1° '1 %Fx , `°'
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