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im BIDING PERMIT APPLICATION
<br /> EVERETT CITY OF EVERETT PERMIT SERVICES
<br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review,
<br /> WA SHI NG TON 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 2I0 j,_p111L- L1�i..�,1,-c11� Avi'_ PARCEL#:
<br /> 'CITY Eve..4--, �
<br /> f± VV A STATE „I'./�
<br /> 1 /
<br /> SUITE/UNIT#: FLOOR#: - ADDITIONAL LOCATION INFORMATION (if applicable):
<br /> •
<br /> TENANT/BUSINESS NAME(if non-residential): /
<br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy ,.,,. .uyal oescrlpuuru)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 7; �L�-17—/jt) j f-i(.
<br /> OWNER MAILING ADDRESS: STREET I il'2t:j$ S; ,4rt y$io/. ,:v-e_ , ' c<�
<br /> cm, 3 ecr( `.. / STATE 4l✓r4 ZIP /g/.i-
<br /> OWNER PHONE: J(O .4; G7O/F OWNER EMAIL: bei,a/2(-ur/hi 6-0 Mitre/ t CCli7
<br /> CONTRACTOR COMPANY NAME: PEc/(_ ;ff/,/tl j ikrci /--/._L
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): (-} ) FCL cr'30VIL,. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> CONTRACTOR ADDRESS: STREET /7'2 03 j,,;lvtY.Sl Le_- Aa'
<br /> CITY Sea Ve._ STATE G1JA ZIP ! V%3 3
<br /> CONTRACTOR PHONE: Ti(, Cocci> -(., 2 C7 CONTRACTOR EMAIL: /)eCL Grin fib_,O b fQr/. Cord
<br /> PRIMARY CONTACT: ROWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME:: CONTACT PHONE: • .C(r,-• 6)SI S7 cv-3- ,:
<br /> 4.1-1 AC.Ct,) f 7-C J& CONTACT EMAIL: r..4-r'h910 ovYea i`1 .C c t--i
<br /> t,(j �.Q BUILDING INFORMATION ,, .'Sif 1,,
<br /> c..4, 1
<br /> VALUATION OF WORK: $ , g V ASSOCIATED LAND USE PROJECT#(if applicable): IIC3 30 2\-'A
<br /> (Valuation shall include the prevailing it mall(et value or an labor,materi s,and equipment needed to complete the work,whether actually paid or not.) P,91 CRG
<br /> EXISTING USE OF BUILDING: .., nF e �%GI
<br /> PROPOSED USE OF BUILDING: C,Gvtve- - t)Ctk—CCi'J-c,'r"1 iv-5 e rl-e X -ft.;, I pis in LA p i
<br /> HEAT SOURCE: ❑Gas Electric ❑Other
<br /> BUILDING TYPE: ESFR ❑Townhouse ❑Duplex ( ,ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> i TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair DTI. 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 /> 00, AoS (vluciciu cd. AvL : (,><kte-f � v;ld;v^�j 4 6( a C. l)OL.t caloc ;. duplex -t
<br /> cz. I p`4) A( Qi•� u - 4- (FLccr- I`� - sl
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<br /> N7 iv� c�' i'iex (On, tS�� / �s �S-r✓Ujr f� l,,s
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<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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Offici714 o 4_al Use Only
<br /> PERMIT# 6
<br /> 0 ner/Authorized Agent ignature Date 1 1
<br /> 2 (Revised 4/21/2022)
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