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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 (E)PermitServices@everettwa.gov (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET E - i //0/LY j i?, PARCEL#: 00378.700 [ CO CITY �� STATE Le-7/ ZIP {() SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): 21:4'01—/Q TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: f i a S p Lot No.: )... (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ,) � /Zip C STI o'- CLit) 7kfucl/Q1J /k C- OWNER MAILING ADDRESS: STREET ()• A ox{{ / L/ 3 CITY /ills -kcji/4/_ L- STATE,\(.�/j /1 ZIP (ye 7 OWNER PHONE: i7,2 5 -8/ b .6 S S--/ OWNER EMAIL: 4 f I�UC L CC`NSTRIra/LA) 4(9)& ct-1 CONTRACTOR COMPANY NAME: ifpz,,1 r 0 s 7o/"1 WA STATE CONTRACTOR LICENSE#(REQUIRED):&xj '[d' (..., CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):5 3.>3-6 CONTRACTOR ADDRESS: STREET � O, ( j 4' () 4' CITY /-�ig/Y.S&V 1% STATE L-0`1. ZIP / c 7 CONTRACTOR PHONE: (lam( 76 -6 S- 7 CONTRACTOR EMAIL:46.>37X/f.)('X'c_$7-0/766/U51/e1,'G (L tie0/&. Cc.let PRIMARY CONTACT: 0 OWNER (CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: j()_3._8 76 S / /69/YUL CONTACT EMAIL: /l�%2 Cc sJ(X`?(c.'Jc �Cll'UX-) //j' au/t. BUILDING INFORMATION VALUATION OF WORK:$ ' , 8_, D 7 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of aU labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: //L L-//i((`1jti ji /U PROPOSED USE OF BUILDING: HEAT SOURCE: jGas ❑Electric ❑Other BUILDING TYPE:) FR ❑Townhouse ❑Duplex ❑ADO ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): Jlew Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use [Nodular DPortable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) DAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: rox 57/LV /L ( J �� D LECEOV, _ OCT 2 7 2023 CITY OF EVERETT Permit SRrvi:r chs 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 property to perform the work for which application is made, unU/comply with fho Stutc Contractors Low/9.27 RCVS,and 290.200A WAC. City of Everett Officialic Use Only PERMIT# /� lJ / r Owner/Author Ized Agentig at a Date (Revised 4/21/2022)