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BI '"_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 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 �j� D 57. PARCEL M <br /> CITY VGi✓ STATE h <br /> ZIP <br /> SUITE/UNIT#: FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): L Coa,. �`„� $�Yt/t�� L L <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 01 u S <br /> OWNER MAILING ADDRESS: STREET &3 <br /> CITY a e STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: M Co A$Lt' ',A ,S-e-fV C PS <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):``;. J _ 4` I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET Q /� ^y• <br /> CITY e✓al Q vA STATE v�A ZIP ' C'y�7-L-7 <br /> 73 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: Ic0 , GJ S ON r Br , C O--1 <br /> PRIMARY CONTACT: ❑OWNER ACONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: _G V I,, CONTACT PHONE: (�0 333 1 5-3 <br /> V CONTACT EMAIL: ' cf n Lsg rCS C 0✓s� <br /> BOIL ING INFORMATION <br /> VALUATION OF WOR : $ SOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prev nd equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: SF I�-- <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: XSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition Aemodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable XRe-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 /> 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 1 am authorized by the owner of this property to perform the work for which application is made. <br /> and I comply with the State C tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> L ZoZZ PE IT#) 205 _0� <br /> Owner uthorized Age Signature Date (Re ise 41 1�0 ?}.� OO <br /> e`�CJ ... <br />