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BUIL—ING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONSt 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 310 Nv rSC" otvj, PARCELM 009;'0"l$0YaOUjC1W CITY evere-W STATE \&(A ZIP 18101 SUITEIUNIT M 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: ` evN a+n.. K'w\ 14,tebv►er- OWNER MAILING ADDRESS: STREET 3(U AWersen I3I4 cnY Fve re STATE W A ZIP OQ57-01 OWNER PHONE: 7 ZO-7-S Z, -y 6183 OWNER EMAIL:1o6)e-)ov,er wvv, CONTRACTOR COMPANY NAME: otvl Ale)( 6ftA U G WA STATE CONTRACTOR LICENSE#(REQUIRED): HAN1> k814`07- ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): G3 Z CONTRACTOR ADDRESS: STREET 13$63 351" Ave /VE CRY 1 l.t Vn I I STATE WA ZIP 11(()CJ(a' CONTRACTOR PHONE: I415-Zz3 - I5 I 1CONTRACTOR EMAIL: c w. PRIMARY CONTACT: ❑OWNER IACONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: I CONTACT PHONE: 1I-L5-'ZZ3 -15-e I CONTACT EMAIL: 4mv,,J.X meo,%Ake Y,Con vwt.�. cra�►�'t BUILDING INFORMATION VALUATION OF WORK:$ 11.t^j (�CY�+°1p ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: 5iv1!%%e. Scindy Rd•i-le►ve PROPOSED USE OF BUILDING: 5iv1 Ie rotrn;ly g aOvnc HEAT SOURCE: ❑Gas NElectric ❑Other BUILDING TYPE: ASFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition %Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof (Stxterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: / �-vtclo$e \-v1'eeZev eA j +4u rv►n.ler- A- i✓iA 0 vvtJd r-ovvv% / �4vN4ri Pvvvrt. /k duGr 10 baclr; ec,r vier �� ara�e 1 uvtd do�.r t.fAy ih+o I:v1'v1 Re,,t,�dal ne�.rcS� hgt�raol.Y► ry }:G �n v►eV Pl��bin' ct"tv,e WASL,er n S�vnl�. DD IE EBY9 ACKNOWLEDGEMENT-I have reviewed this application and confirm the Information contained herein Is true and corre . k done pursuant to this permit musLcofnply 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 pro�e yToY-@,}n tlE-VFlR f-h1TliTppllcation is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. P Ciry'0lEYe 94cf9tfsbr0nly PERMIT# Owner/Authorized Agent Signature Date (Revised 412112022)