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BU" DING PERMIT APPLICATI' v CITY OF EVERETT PERMIT SERVICES � �Pf EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirement num a0ryeirfE iew, WASHINGTON then drop off completed application plus all required submittal documents to 32 edar Street 2nd Floor Intake D ox. CONTACT INFORMATION:(P)425-257-8810 (E)PermitServices@everettwa.go )ev ra� /p yoPe (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET I ©� �C� ► t PARCEL#: (7O LTS CITY Evzrtw STATE WA ZIP O SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): j TENANT/BUSINESS NAME(if non-residentiai): .1� i LEGAL DESCRIPTION for new construction: Short Plat/subdivision:Rl 4ert t xl LAdd Lot No.:an �Q(attach copy of long legal description) CONTACT INFORMATION OWNER NAME: C r culvIII n OWNER MAILING ADDRESS: Qj STREET 16 2 NC- I Ot CITY & STATE WA ZIP 6201-1 OWNER PHONE: CR O(p 1 I OWNER EMAIL: C.hcNv )C I rv5CD puroe-1can . 0-ory'1 CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIR/E� u D):� AdCA�350J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O�7J CONTRACTOR ADDRESS: STREET C�LJ(b (- 41-) VI NE CITY , STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR QKOTHER(Please Specify) GCLhkCiL± F CONTACT NAME: CONTACT PHONE: a7 C�LP.. Hay- 'y n 6 Q Lb-e-- + CONTACT EMAIL: ny)ar fiti BUILDING INFORMATION VALUATION OF WORK:$ 1� �0 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevaiing fair ma et value of all labor,materials,and equipment needed to complete the work,whether acluaHy paid or not.) EXISTING USE OF BUILDING: PROPOSED USE OF BUILDING: �'— HEAT SOURCE: Gas ,Electric ❑Other ✓(1f f' J BUILDING TYPE: NSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure J TYPE OF PROJECT(check all that apply): k]New Construction ❑Addition I�LAemodel %epair ❑T.I. ❑Change of Use ! ❑Modular ❑Portable ORe-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: -{ �"— � bYml `>�' 4-1 Ile V 4. �`=.:��••�..��"�� '✓J `'�' rat,.:/.�,•► �`� .T�y`;�7� :3 �' 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 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 Building Official before being authorized under 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, and!comply with the State Contra tors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# � \ W Owner/Authorized�q nt gignature Date (Revised 412112022)