Laserfiche WebLink
BUILDING PERMIT APPLICAI jN <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 />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 C J'� PARCEL #: <br />CITY L77 STATE A— ZIP 3 <br />SUITE/UNIT M FLOOR M 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: 0,t <br />OWNER MAILING ADDRESS: STREET <br />CITY �V E� aAt5 STATE I/ V A_ ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR COMPANY NAME: <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />i ' /6 1 + 11 <br />t', �l�k <br />CONTACT PHONE: l- -)? <br />CONTACT EMAIL: G rtlj <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ uo ASSOCIATED LAND USE PROJECT # (if applicable): <br />(Valuation shall include the prevailing fair market value of all labor, 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: []Gas ❑Electric ❑Other <br />BUILDING TYPE: ❑SFR ❑Townhouse []Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />TYPE OF PROJECT (check all that apply) : ew 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: <br />D EVEOVE <br />J U L 21 2023 <br />CITY OF EVERETT <br />f' 14 S c_-;� �Z3 Permit Services <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 I 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 />PERMIT# 0236 ^ R <br />(Revised 412112022) <br />