Laserfiche WebLink
E BUILDING PERMIT APPLICATION rCEINIE <br /> EVERETT CITY OF EVERETT PERMIT SERVICESSUBMITTAL INSTRUCTIONS:Sde applicable submittal checklist for submittal requirements andf copies required for revie <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 C '`2Nd`FIr lr3nt4 �rop Bo <br /> CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov I (Va.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY OP Er,/ ET <br /> �� y " C-Cr1G-- (. .--1. PARCEL#: 't <br /> PROJECT SITE ADDRESS: STREET � `� � �'ti� �i���l;t Services <br /> tf'E'/RIIIT CITY STATE4 ZIP q •` 7 <br /> 2. <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:C-!X/3 4 3 ) Lot No.: ?) (attach copy of long legal description) <br /> CONTACT INF MATION <br /> OWNER NAME:P IL-t1lZENt�t',> /C <br /> OWNER MAILING ADDRESS: STREET 7I ��/� ) 3 �� 1 C�(/� <br /> sfi,/' <br /> L-- Y� -/�-6^ CITY STATE v_,4 <br /> / ZIP qe?� <br /> OWNER PHONE: 92 r 2- .-6 6? 9 376 OWNER EMAIL:PM-4C A-6(i^&D(/L� �/ f. > <br /> CONTRACTOR COMPANY NAME: C0 qq C v� 0(..,t 1' <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: ErOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME• CONTACT PHONE: /Z-9-2- Z6fc� _ y j 7.6 <br /> CUB C� 1. krA , =e �` '� /� , �j <br /> / � � CONTACT EMAIL: ��-ri-�C"/�GCf�i�tX1/`�f✓F- •f26r--74; Lx7y/i7- <br /> BUILDING INFORMATION <br /> `VALUATION OF WORK:$ / /J/ 00 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all la materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: . <br /> PROPOSED USE OF BUILDING: J / i tie rt if----? / y 5i7 'C' <br /> HEAT SOURCE: EGas,r EElectric ❑Other <br /> BUILDING TYPE: VSFR ❑Townhouse ❑,,l�Duuplex ❑ADU EMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): I�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) ElOther: <br /> DESCRIPTION OF WORK: <br /> e- -214 .,-.'777-<-<e"-Troc( o tr et S /y,--6'(e I'a-P 7 /X /Ze,c / 0.,e_€/Ce <br /> ACKNOWLEDGEMENT::I havewed 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 loca a 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 bein u orized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Stat Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> -7 <br /> PERMIT# 13. (3,30 <br /> -• 0 4 — 0. <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) S /��� <br />