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Bl" .DING PERMIT APPLICAT N <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for reviev <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Bo, <br /> CONTACT INFORMATION:(P)425.257.8810 1(E)everetteps@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET C ^5 Si ��{// AlAtL ; PARCEL#: �1 CITY lt—:q STATE t FT ZIP C ZL, <br /> 1 � <br /> SUITEIUNIT#: 102, FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): rl GA}y W S. <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: attach cop <br /> y py of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: tlS LIP Fes' Q ;JG <br /> OWNER MAILING ADDRESS: STREET <br /> CITY G STATE �/.i ZIPS' <br /> OWNER PHONE: %v� "1 2, $,✓,3 L OWNER EMAIL: UL5 L;� �" <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY <br /> STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: `r"S"Prat 6�J CONTACT PHONE: *-/Z zSS-3Z <br /> `� CONTACT EMAIL: uS itiS �vA ,L,s•y, <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ Z.`' Ci 01 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: S40 <br /> PROPOSED USE OF BUILDING: S' I-e <br /> HEAT SOURCE: 26as ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse []Duplex ❑ADU ❑Multi-Family-#Units: 12rcommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction SAddition ❑Remodel ❑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 /> ti _ �� er CJ(A�'q,—X n i.v Gl�l `I t Ql.vf <br /> Q GL ttt��GL✓� .v�%� S i ✓� (� 1+i ems.-� VL G' d st'l k CA-3 d <br /> ACKNOWLEDGEMENT.,l 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./am the owner,or I am authorized by the owner of this property to perform the work for which application is made <br /> and I comply wi"e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> "0 ZZ <br />