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B DING PERMIT APPLICATI*I <br /> ECEOVE <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements an n ber deer u Dior revi <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 C treet 2nd Floor n 'Drop Be <br /> CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@evereftwa.gov I(W) rmits <br /> LVERE <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION Pst'Ci.t , <br /> PROJECT SITE ADDRESS: slr I 4102 C(.AF1 PARCEL#: OO 47 OO8t0 ( r <br /> CITY G W IIVVI STATE W ZIP �!1 s20 <br /> 3. <br /> SUITE/UNIT#: (,!e FLOOR#: /J 44S ADDITIONAL LOCATION INFORMATION(if applicable): /•S/ r <br /> TENANT/BUSINESS NAME(if non-residential): 0(- Pcf•Y IjdCW ki)i FAY1'►P[.`f ttOM 6 • <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: of/Wet- G 1-((JP <br /> OWNER MAILING ADDRESS: STREET 4(O Z 614 FF b I` (eve (T r <br /> CITY � L"f'•y� (� STATE V'V-,A-�'' ZIP 203 <br /> OWNER PHONE: ?7 l 37 j ( 4'4 5 OWNER EMAIL: Lali fp <br /> (� W' — I✓ki) 2 2•`, 9%Yl 9 I'(Dr)'t <br /> CONTRACTOR COMPANY NAME: —H 0 c,l� _(�-PO U(& <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): t/A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t `t_ <br /> CONTRACTOR ADDRESS: sTREET 4/A f't '/ <br /> CITY ij/ - STATE /v7A- ZIP {^'/A <br /> CONTRACTOR PHONE: /4-//\ CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR X OTHER(Please Specify) 17G> 61K <br /> CONTACT NAME: pp��g CONTACT PHONE: 2C.2 3J�'"� $ C�Z7 <br /> Y'I CI t-71 CONTACT EMAIL: tN I(c�oCSl�( y y („44(l{ ovyi <br /> BUILDING INFORMATION `/ <br /> VALUATION OF WORK:$ !r)/f1'0 9 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: uV( F YJ4f( Oi'14 <br /> PROPOSED USE OF BUILDING: Apv L7 IL`1 K(7M <br /> HEAT SOURCE: ❑Gas fig/Electric ❑Other <br /> BUILDING TYPE: ' SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ARemodel ❑Repair []Ti. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub Drank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> tT :rah 4' T1-(E; (�N�16�fS ( Tc__MA-lce Ur A i 1 C <br /> PTt oOIV'. 6v44c-R� c FT(NI (mi4 Gc ( awe (/iT A4- i Zeon^ f2,7 <br /> W1tLL• CONS-MLIC Tt/JGt- RINM' • <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.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Co Law 18.27 RCW and 296.200A WAC. <br /> pity of Everett Official Use Only <br /> • <br /> PERMIT# J <br /> 0(72( / 2: 6'230 <br /> 3 b -c 7 <br />