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man <br /> BUILDING PERMIT APPLICATION <br /> E V E R E T T CITY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal Checklist for submittal requirements and number of copies required for review, <br /> 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.gcv I(M everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: SrET I Z Z� <br /> ra PARCEL#:00 ] I vLQ D <br /> } 44 <br /> I STATE Irt/x ZIP dl�2 O <br /> Cr'r K R i'r <br /> SUITEjUNIT#: FLOOR# ADDITIONAL LOCATION INFORMATION(if applicable): <br /> TENANTIRUSINESS NAME(if non-residential): <br /> LEGAL bd <br /> DESCRIPTION for new Construction: Short Plailsuwisnon: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME <br /> OWNER MAILING ADDRESS: STREET LE2 7. JAJ N w+° <br /> CITYG +44 STATE VIA DP <br /> OWNER PHONE:Z C E-c)u (I 5' 1 0w�N�ERE� � <br /> MAI <br /> W <br /> CONTRACTOR COMPANY NAME: r -�/ <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> G'r'r <br /> STATE nv <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Z OTHER(Please Specify) CC' 11 <br /> I' <br /> CONTACT NAME: CONTACT PHONE:Z�'-3 4.1;L G(g <br /> CONTACT EMAIL: rk.e[{ <br /> BUILDING INFORMATION <br /> ALUATIONASSOCIATED LAND USE PROJECT#(if applicable); <br /> au:aucn 5ttall inUuoe C'.e PrCvail�ry'au maftr[t vaaWe of as neon.mmenaLS and aeWPment neeceo Io comolene the work.; elver actually Palo or noL) <br /> EXISTING USE OF BUILDING: A 0.iA SAS <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: Gas dElectrlc COthef <br /> BUILDING TYPE: ❑SFR CTo L� <br /> wnhcuse []Duplex .1ADU F6Mulp-Family-it Units:_ L Commercial L,.Ccoessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction []Addition (]Remodel ❑Repair OT.t. []Change of Use <br /> []Modular ❑Portable []Re-roof ❑ExteriorAltetation F.-Tank(above ground) CAccessory Structure <br /> OFence over 7ft high CRadkStorage []POOUHot Tub []Tank(above ground) ❑Other. <br /> DESCRIPTION OF WORK I <br /> II Ilrj �I-p ;^trILG rc:.rvT lc�� wwS,Gl ttx.� �r/iJ C(,; <br /> f i r�'tYri6f ✓y <br /> L�IOngSn4 r�i Y���n.i,T-✓rn �s�rn I-I <br /> / i 3 <br /> im <br /> A CKNOWti6GEMENT::have reviewed inns appucatmn and Confirm the information contained herein is true and correct Wwl<done pumuani ro rt s ^ aY�v`InJMe E T <br /> pe <br /> Caren;federal,state,and local law fie granting of a permit only authorizes approved work and no deviations merelrom.Deviewss m���?t^oE t w r..h ceftd�.+S�y/r�j <br /> BunMmy Officialrce�.Slareng(authonze under any <br /> 27 RC Circumstance i am me owner,or i am authomed by the owner o/fn2 properly � ��t Service s <br /> and/comply City of Everer 0 <br /> [ PERMIT# <br /> Date (Revised I212022) <br /> Owner/Authorized Agent Signature <br />