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BUILW', PERMIT APPLICATION <br /> Cl, .f EVERETT PERMIT SERVICES <br /> EVERETTSUBMITTAL INSTRUCTIONS:Soo applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WAS,,,n G T pry then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425-267-8810 1(E)PermilServices@everettwa.gov I(W)overettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET hu 0 PARCEL#: 00ZZ�3 <br /> STATE VA ZIP <br /> CITY <br /> SUITE/UNIT#: FLOOR M /- ADDITIONAL LOCATION INFORMATION(if applicable): <br /> TENANTIBUSINESS NAME(if non-residential): vlePnyl,.�c�S S t! <br /> LEGAL DESCRIPTION for now construction: Short Platisubdlvislon: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: de( ,r <br /> OWNER MAILING ADDRESS: STREET IUS CI 'r ✓'_. +i y <br /> STATE W!t- ZIP <br /> OWNER PHONE: //15 3ZO-4111A OWNER EMAIL: <br /> l �1 <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRE)): C,nUl� <br /> CONTRACTOR ADDRESS: STREET k p'1 (,V lf` AurVvy <br /> E <br /> CITY l)fU .+ STATE W zip 191(1 Z. <br /> CONTRACTOR PHONE: 3G0�y25'-1 CONTRACTOR EMAIL: got, SV,5 6) <br /> PRIMARY CONTACT: RfOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: A CONTACT PHONE: Z0(p q7/ - 61/P3, �i�/c�(�� <br /> ` rC-Wr ilvw111 CONTACT EMAIL: r,? 61 <br /> 1 BUILDING INFORMATION <br /> VALUATION OF WORK:$ 1 5.(Vl; ASSOCIATED LAND USE PROJECT# if a licable: J <br /> (Valuatbn aha8 include the pra,a,ng fair marke'tgvalue of al labor,maleda's,and equipment neodad to compbte the unrk,whether aclualry pab or rwl) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: : <br /> HEAT SOURCE: ❑Gas ❑Electric 001hef <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-It Units: ErCommerc)al ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition RIRemodel ❑Repair ❑T.I. ❑Change 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 OF WORK: <br /> oar c;A d,r b/al, t c c1�5 cv�s <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained heroin Is true and correct.Work done pursuant to this permit must comply with <br /> curronf lodoral,state,and local law.The granting ore pemut only authorizes approved work and no deviations therefrom.Doviations must first be authorized in writing f is made, <br /> the <br /> Building Official before being authorized under any circumstance.lam tho owner,or 1 am authorized by the owner of this property to perform the work for which application <br /> end I comply with the State Contractors Law 1 g.27 RCW and 296.200A WAC. City of Everett Olticlal Use Only <br /> 9� PERMIT# <br /> C1v� <br /> OWnorlAuthorizod Agent Signaturo_ Dale <br /> Revised 4/21/2024 <br /> NL C�[ �ML <br /> FEB 16 20A <br /> CITY OF EVERETT <br /> Permit Services <br />