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BU..-DING PERMIT APPLICATILA <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 /> WASH INGTON 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 2523 State St PARCEL#: 00483557800500 <br /> cm Everett STATE WA ZIP 98201 <br /> SUITEIUNIT#: 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:Julie and Michael Larson <br /> OWNER MAILING ADDRESS: sTREET 23704 150th St SE <br /> My Monroe sTATE WA ZIP 98272 <br /> OWNER PHONE:206-295-9506 OWNER EMAIL: AK08PropertiesLLC@yahoo.com <br /> CONTRACTOR COMPANY NAME:property owr <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> Cry STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: I]OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-530_8393 <br /> Michael Larson CONTACT EMAIL: AK08PropertieSLLC@yahoo.Com -I-,CkAej a( <br /> 3 <br /> 2 BUILDING INFORMATION <br /> VALUATION OF WORK:$100&0 1`` ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market valuebf all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:Residential <br /> PROPOSED USE OF BUILDING:Residential <br /> HEAT SOURCE: []Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑✓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:Replace old or broken windows with same size or smaller, reframing as necessary; <br /> reframe 2 exterior doors to fit new 36" doors; extend bathroom wall by 18", reframe <br /> back porch to support new board siding; relocate center wall and kitchen entry; <br /> relocate bedrooms and add closets; new ceilings for kitchen, living and bedrooms. <br /> ACKNOWLEDGEMENT.1 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.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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT ^ � ))C)� - <br /> Ownerl uthorized Agent Signature Date (Revised 21812021) <br /> w 22 2p 1 - oo Ck <br />