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p CcEpyrp <br /> BUILDING PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES JAN 2 6 <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requiremen s d number of copieNrrouired f view, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 320 rop Box. <br /> CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everethva.gov e p g1mir—Iff(Blue or Black ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET "C) v(& PARCEL M <br /> Cm r, veraf I STATE W ZIP qL 0 <br /> SUITE/UNIT M FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANTIBUSINESS 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: > (^ <br /> OWNER MAILING ADDRESS: STREET r O kC '( V <br /> CITY 1=Vert' STATE L/it ZIP � t <br /> OWNER PHONE: 1OWNER EMAIL: ferl2 t; , Q coat G 0� <br /> CONTRACTOR COMPANY NAME: } rn L Coil j-r(AL, ,,oh <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET U"l 6 L ( 1� <br /> CITY AWA rrl f� STATE V& ZIP <br /> CONTRACTOR PHONE: L�Z� �- 3(99 CONTRACTOR EMAIL: SOW e r L2 <br /> PRIMARY CONTACT: ❑OWNER MCONTRACTOR dOTHER(Please Specify) A44 h r FYJf el`°1Giq, <br /> CONTACT NAME: CONTACT PHONE: 206— 2 q 5` &W <br /> V o/( n boir hvL' - ICONTACT EMAIL: Vet ,l`b rA ,)Nk f CO <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ 000 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall inciudo the prevailing fair markot valuo of all labor,materials,and equipment neodod to complete the Kbrk,whether actually paid or not,) <br /> EXISTING USE OF BUILDING: Q el*ls 1,10me C r (/f Ut y ) ui5 e Gl rtn OII <br /> PROPOSED USE OF BUILDING: kc 'IdVA Ind M <br /> i <br /> HEAT SOURCE: []Gas lectric ❑Other <br /> BUILDING TYPE: WSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commerc(al ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition IKRemodel ARepair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterlor Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑PoollHot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:D(mnt7 wall c� `t) Mawr 6edroof" ( ( r4h 1()0r1 1 r Cj/1j C10 NGeA <br /> ;o t-t of d r�(`�c�Y I0e9 kv':Ge-" k-,$L�?h 'I k ;() f-001 , � 11 k"'q C1/12h <br /> YtOr ja(4ndry ruoh (emOdd ( lour)rjorl rojode I t reFivdr;11) Of- `IhdIe KcM, C( <br /> rztdca► ,'On of �hO-ff\ to'Igr re j^10,'ij!4 i, M er bccffiroolm . <br /> ACKNOWLEDGEMENT.!have reviewed this eppl7ca0on and confirm the lnformatlon contained heroln 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 clrcumstanco.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and f comply tvith the Stole Contractors Law 10.27 RCW and 296.200A WAC. <br /> City of Everett Olficlat Use Only <br /> PERMIT# <br /> bl r *zoz <br /> Ow*/Aufflafiz nt Signature Date (Revised 412112022) <br />