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BLr DING PERMIT APPLICATI 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 /> WASHING70N 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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET JG 5'f` PARCEL#: (;05 i Q Cif / p <br /> CITY STATE k kyI ZIP Q �•'I <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS 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: P T fu s <br /> OWNER MAILING ADDRESS: STREET 12 Z E C �.,gig T� I S I' <br /> CITY �> V"C' V^A •�\ ° STATE ZIP -/8-C<71 `j <br /> OWNER PHONE: 0 Z S 3 SC -i 6 Q l OWNER EMAIL: j-SCA-�'L � ^C,t f'%1Ci C : r`G i'vi <br /> CONTRACTOR COMPANY NAME: K ol ;Ie-" E hQ�j <br /> WA STATE CONTRACTOR LICENSE#(REQUI - vet VV 5 e� V12 C(? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET �Z 21 l S r o <br /> CITY S-0 G Vic, ►M 1�y1 - STATE ZIP � O V <br /> CONTRACTOR PHONE: l Li7-51 77�jb - IG 0 t UI CONTRACTOR EMAIL: {7G< 'jK c, <br /> PRIMARY CONTACT: OWNER ONTRACTOR THER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C l" S 3 S L° - C: <br /> CONTACT EMAIL: V-f-'S G('0 b10 C6 M <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: CjCc- ASSOCIATED LAND USE PROJECT# if applicable): <br /> (Valuation shall include the prevaiTint fair market value of all labjbr,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: as lectric ther <br /> BUILDING TYPE: }, FR ownhouse uplex DU ulti-Family-#Units: ommercial ccessory Structure <br /> TYPE OF PROJECT(check all that apply): ew Construction ddition emodel epair I. hange of Use <br /> l� <br /> oLj <br /> dular �ortable e-roof xterior Alteration ank(above ground) ccessory Structure <br /> ence over 7ft high ackStorage ool/Hot Tub nk(above ground) the <br /> r: <br /> DESCRIPTION OF WORK: ceNll�'�G'_b, wc,ll�j 5(7✓V, GlO)C�� <br /> E[eC"I1 rCC1l(,tir Gtv►l ' <br /> 2109 — c� t <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.I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P MIT# <br /> Owner/A" A ignature 91te (RevisedM12021) �z <br />