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L 1LDING PERMIT APPLICAT. ;N <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)evereUeps@evereUwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1 a _ 9T!� A-jEtjLjff 5.�. PARCEL#: (gyp <br /> CITY FJ F�G'�j' STATE \,�A, ZIP �.jI — <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANTIBUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: �}t ,�l t A Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: + A p <br /> OWNER MAILING ADDRESS: STREET`11 p-1 A j Nu 5.E. <br /> CITY ��(EQLr'r STATE ZIP `1gj <br /> OWNER PHONE: OWNER EMAIL: ,g @ �, � . C�v✓1 <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED). Q,t fL S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S <br /> CONTRACTOR ADDRESS: STREET Z�ID• zj` C , <br /> CITY LA�� �E�E STATE ZIP 'iBZrjg <br /> CONTRACTOR PHONE(47S 1CONTRACTOR EMAIL:����ndsO,na\�Ctim�\ 2 \ •Co <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR BOTHER(Please Specify) tStt�al— <br /> CONTACT NAME: '� ���� CONTACT PHONE: (Z,L ) 2.2 .bt�lo� <br /> GAJ A�t t�l. ' 1JESi CONTACT EMAIL: do t o e C'� <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ I OG cco ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall Include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: StaUts FA,MtL <br /> PROPOSED USE OF BUILDING: 4A <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: MRSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction INAddition ❑Remodel ❑Repair ❑T.1. ❑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: tit Sur-► tv-c oYF � [ ot= �t,sa r+L._ G�gC2�,� a2�o• �s o�c`�L <br /> t a"I tIV, bo4l�lwf how <br /> p <br /> NOV 0 6 2023 <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein is true and correct.Work done p�suan odhi a rthCr�t? �mjily with <br /> current de al state,and local tali.The granting of a permit only authorizes approved work and no deviations therefrom.Deviallons m st l u rWrf SQ06g from the <br /> Buiidi g ONicial bet re b ing authonz dunder 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 /> d 296.200A WAC. <br /> and I c mply with a ate C. <br /> tors Law 18.27 RCW an <br /> City ofEverett Official Use Only <br /> PERMIT# &A 2 f 1 O ( s <br /> 1 .JI <br /> wn I t razed Agent Signature Date (Revised 21812021) <br />