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BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425.257.8810 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET Y1 IQ LrS , PARCEL#: 3 v �d U CITY STATE6/hq ZIP W2 SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: S OWNER MAILING ADDRESS: STREET } S CITY STATE IA ZIP 9 U,122 OWNER PHONE: .2-3 �2— OWNER EMAIL: S(/SCr✓,{/ l l G Q CONTRACTOR COMPANY NAME: S L WA STATE CONTRACTOR LICENSE#(REQUIRED): Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET S Q CITY s�/ ( STATE IA14 ZIP aeI62 CONTRACTOR PHONE: OC o }� G �' �� CONTRACTOR EMAIL: /C 6C114 F_ 1*41e- �U PRIMARY CONTACT: ❑OWNER RCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: MW 000NTACT EMAIL: C C BUILDING INFORMATION VALUATION OF WORK: $ 13 Y •Qd ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair rKarket value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: HEAT SOURCE: ❑Gas [12 lectric ❑Other BUILDING TYPE: V9FR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial []Accessory Structure TYPE OF PROJECT(check a//that apply): ❑New Construction Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: Y�1r,� /Z! �i / / ��(rO;Ci) 134 I �U�0�` /> /,?o l, 7'" 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 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 Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT#-?)�m Owner/Authorized Agent Signature Date (Revised 21812021)