Laserfiche WebLink
0 <br />0 <br />am <br />® BUILDING PERMIT APPLICATION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />WASH INGT ON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box <br />rnN1TAr`T IA1Cl1DIU aT1r1 A1• !Pl A7ri 757 Rat() I tF1 (?V t'((?tte OSneverettlVa (lov I I:hi) everethvi gov/Nnnits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STRE:_r �C I ' `j h L PARCEL #: <br />c'- L�lC'1AA STATE 11�1LL ( ;. ,' o' _) <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): <br />LEGAL DESCRIPTION for new construction Short Plabsubdiwsion - Lot No (altid, copy of Iunp legal dr;criphonl <br />CONTACT INFORMATION <br />OWNER NAME: C -� r-r( I, <br />7 C <br />OWNER MAILING ADDRESS: ;TRHT C; L i" ) " <br />L I' <br />ciTv IfAli <br />OWNER PHONE: <br />OWNER EMAIL: �� 1 c� 6' ? ✓� l <br />CONTRACTOR COMPANY NAME: 'v/A <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE £l(REQUIRED): <br />CONTRACTOR ADDRESS: STRErI <br />c,T.. ,rL <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: XOVVNER <br />ONTRACTOR <br />THER (Please Specify) <br />CONTACT NAME:: <br />CONTACT PHONE: <br />�\ -.(i' t' 1 <br />CONTACT EMAIL: ,I <br />BUILDING INFORMATION" <br />VALUATION OF WORK: S =�200 o 09 <br />ASSOCIATED LAND USE PROJECT # (if applicable): <br />Ia N::Y ;'sn :'I m ..."•'I :. r :: 1 1, � 1; .uti! vSur- 0,1 Libor. matvmltl and equip moat T i,vd, d to con¢tcto IhC n. t 1 <br />EXISTING USE OF BUILDING: Ir <br />PROPOSED USE OF BUILDING: -5e <br />HEAT SOURCE: <br />r <br />BUILDING TYPE: <br />ti <br />F <br />�.�o�ljplex <br />DU <br />hilU-Family - #Units <br />omnlercial <br />ccessory Structure <br />TYPE OF PROJECT (check all thrit apply) : <br />Li ew Construction ddition <br />emodel X/ epalr 1 hange of Use <br />Iodular ❑ortable e-roof xtenor <br />Alteration ink (above ground) <br />cclessory Structure <br />;ace over 7ft high ackStoi <br />ool/Hot 1Lb ank (above ground) <br />thor <br />DESCRIPTION OF WORK: <br />1 n , n <br />(�c 1 � (.i D p <br />rRe� tt <br />-e-w--9! <br />- <br />"e, '�Up <br />ACKNOWLEOGEMF_N r t have roviowod This oppbcnbon and confirm the Information contained herein is true and correct Work done pursuant to this perrlat must comply w(th <br />currant fsdarat, ctatoand local low The granting of n pannd only outhonms approved work and no dewaeons therofrorrl Deviations must first be authorized in wnt:ng ham the <br />Budding Official before being authonrod under any Circumstance 1 rem the owner, or 1 am aurhon:ed by the owner of this property to perform the work for which application is made. <br />•nd I compty with the Stnte Contractor. Lew 16 27 RCW and 296 200A WAC <br />7 City cf Evere t Official Use Only <br />f ` PERMIT # <br />Owner Authorized A nt Slpnis uto Dal (Revised 2 B 20211 <br />I/Z- <br />