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BUILDING PERMIT APPLICATION <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 �l <br /> PROJECT SITE ADDRESS: STREET i 2i1U� PARCEL#: J 00 <br /> CITY �— Z.{r STATE W 14 ZIP 962C) <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: <br /> OWNER MAILING ADDRESS: STREET �'{1 <br /> CIN yea It STATE ZIP 17 r 0 <br /> OWNER PHONE: `J — 3 - (-)2- OWNER EMAIL: r ' 4 r-�he JY)C L Co-(Y\ <br /> CONTRACTOR COMPANY NAME: e .1 C <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): S-MS + ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)::#51-11 155 <br /> CONTRACTOR ADDRESS: STREET RCI I SU <br /> CITY r l STATE 'VV ZIP 01P)22.0 <br /> CONTRACTOR PHONE: - - oe)qq CONTRACTOR EMAIL: '�Y)fuO' stcrmo0t i, n C,C(w1 <br /> PRIMARY CONTACT: ❑OWNER N CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> u Hasa s���ch W-74 ip - c ts} <br /> VI� r CONTACT EMAIL: r ^f` '�'I�S(�IC{'�f7C, cDol <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ ';: Cq 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: JER <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): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration []Tank(above ground) ❑AccesssoryyStructure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) Other: � JLAQ <br /> DESCRIPTION OF WORK: <br /> TnS+at k 5 a V- \'9V S�S�CiM� ci v 0 Z \,--Vti <br /> MccAuleS i PUy-1wonkc ztko 13ab C22) <br /> i h ers : ErDha S e "eY9y i& E31- 622) <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 ate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ID /3 <br /> er/A orized Age na ure Date (Revised 4/21/2022) <br /> (� <br />