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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 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET '/���r P� �V PARCEL#: <br /> CRY -!Y C--�e-- STATE WA- ZIP 03 <br /> SUITEMNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ��rUCS L�IvE /— t 11Z(•"/ <br /> OWNER MAILING ADDRESS: STREET '(3 ( S �.O 1 J r• S G t <br /> CITY U J2_(� STATE ZIP Q r Z <br /> OWNER PHONE: 3 O.3 XO OWNER EMAIL: I C rtitG I I Co w. <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE,# <br /> CONTRACTOR ADDRESS: STREET ) <br /> CITY STATE zip <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: CITY 0 <br /> PRIMARY CONTACT: Er=ER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: <br /> V'"'_v (� I�tLI/Z ( ,—A CONTACT EMAIL: u aiv j c F, - Corh, <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ D V OU V ` 00 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall Include the prevailing fair market value of al labor,(materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: I (_Q <br /> PROPOSED USE OF BUILDING: C7(�t' rLs�►�w (�.� ( t•Lt i Ltlti <br /> HEAT SOURCE: PlIas 0 lectric ❑Other <br /> BUILDING TYPE: OFFIR []Townhouse ❑Duplex ❑ADU []Multi-Family-#Units: ❑Commercial []Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition 6 model []Repair ❑T.I. 19 hange of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration []Tank(above ground) []Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub []Tank(above ground) ❑Other: <br /> DESCRIPTION F WORK: L ( , ar C�CC S$I � Le- <br /> i vt 1 eV <br /> N(ScA/� <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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply vnth the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0y �V PERMIT# 0 <br /> 4 <br /> Owner/ utho zed Agent Signature Date (Revised 412112022) J <br />