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E BUILDDG 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 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET L700 4(;t 1T7v yt __kl. 0 LI PARCEL#:'r` �qJ�//1�1 <br /> CITY L''�ile.k STATE J.)P ZIP 1g70 3 <br /> SUITE/UNIT#: k 0 Li FLOOR#: \ ADDITIONAL LOCATION INFORMATION (if applicable): 1VV <br /> TENANT/BUSINESS NAME(if non-residential): Rcpll',0 A <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L,\J (D7001 LL C <br /> OWNER MAILING ADDRESS: STREET 3323 0C 1(3s4 5}. I 5�, Goo <br /> CITY Y k a1M STATE -- L, ZIP 331 t v <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: W C i-p; GC r Li,(;'- <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):Og51-"QCL,61,ikeriAY OF EVERETT BUSINESS LICENSE#(REQUIRED):6/6:G <br /> CONTRACTOR ADDRESS: STREET 54 y2 c2-o &J 1.) <br /> CITY ( S-17',�,Sj '.J STATE p l_ ZIP gyps� <br /> ?��e <br /> 'CONTRACTOR PHONE: ( 960 ,W ArZ CONTRACTOR EMAIL: �r 3r,:�a \ C e`4 <br /> PRIMARY CONTACTT- -OW4dER LI CONTRACTOR X OTHER(Please Specify) t2.,A tart <br /> CONTACT NAME: CONTACT PHONE: 4Z5- 9-7 (- 357 2 <br /> \(I-e 1AC j CONTACT EMAIL: -- III; r t t'�l( ,,,yi , 1, ,,vl <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$'7(p`000 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: {"_LAAAA-Pf <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse EDuplex ❑ADU ❑Multi-Family-#Units: glCommercial EAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ET.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 /> V-Zvi,A0\J- '- , 1 . 1 wA6 c Z'Le -Spc,t-12. ct5 ;,11c,e cti.-efi.-. EcE R —pOM <br /> MAR 14 2024 ji—r- 0 <br /> CITY OF EVERETT <br /> Perms 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 fore 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 1 comply w' t State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I City of Everett Official Use Only <br /> .( PERMIT# -� <br /> 2J2 �' dos -0 q 6 <br /> Owner/A th rized Agent Signature Date (Revised 4/21/2022) <br /> J <br />