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1161. BUILDING PERMIT APPLICATION <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 /> ROJECT SITE ADDRESS: STREET t5!t ‘,..0 ,�.! (I PARCEL#: <br /> CITY L1f STATE ZiP c i c- L i! t <br /> iIJITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): !r <br /> 'ENANT/BUSINESS NAME(if non-residential): ETtl, mice-rb \rl,,e..cs1r r4r) L. LC <br /> EGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> MINER NAME: EE'IV Peutc, I vi%c,0 rbweJ c LL C. <br /> IWNER MAILING ADDRESS: STREET 2) )^V►,. ,,r14- j(_�; )r <br /> CITY EM I,C" �• STATE wA ZIP CtgZc <br /> IWNER PHONE: '1 A I "k1`i 28'2.\ OWNER EMAI : eie..Q n Peed.". :"46..le 0 5 r'rtw. l . L0 to <br /> :ONTRACTOR COMPANY NAME: ' 7-CCC' '- ir m-2_ cl.‘fil• <br /> VA STATE CONTRACTOR LICENSE#(REQUIRED}� (. tom- 1� a� � 'Y OF EVERETT BUSINESS LICENSE#(REQUIR;� !,b.1 <br /> :ONTRA OR ADDRESS: STREET <br /> CITY ATE u <br /> :ONT CTOR PHONE: CONTRACTOR EMAIL: <br /> 'RI Y CONTACT: 0 OWNER 1ONTRACTOR - FTHER(Please Specify) <br /> :ON CT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> 'AL ATION OF WORK:$ ASSOCIATED LAND USE PROJECT#(if applicable): <br /> taluat n shag include the prevailing fair market va)ue of all labor,materials,and equipment needed complete the work,wImether actually paid or not.) <br /> XIS NG USE OF BUILDING: <br /> 'ROP SED USE OF BUILDING: <br /> TEATS URGE: ;as her <br /> IUILDING PE: :FR townhouse uplex riDU f Multi-Family-#Units: t commercial r—lccessory Structure <br /> YPE OF PR&JECT(check all that apply): ew Construction [Jddition I}emodel Repair U.I. Uhange of Use <br /> jlodular [ortable e-roof erior Alteration ank(above ground) ccessory Structure <br /> ence over Tft highr1:13 <br /> ackstorage ool/Hot Tub lank(above ground) her: <br /> IESCRIPTION OF WORK: t <br /> et,J :�.tDm�Oo ` <br /> faDr <br /> v_e,pk- r- rii -.0c--- - Aut:os.,,ct -Ll -,m‘,4 <br /> CKNOWLEDGEMENT: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 /> lrrent federal,state,end 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 /> uilding Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> nd/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> C: z_',-.....:.-- f• ____Th. <br /> water/Authorized Agent Signature ate (Revised 2/8/2021) <br />