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r-� BL_I DING PERMIT APPLICATLA CITY OF EVEREIT PERMIT SERVICES EVERETT SUBMriTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and.number of copies -required for review, WASHMGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425-257=88101(E) PermitSetvices@everettwa.gov ( (M everettwa.gov/permits PROJECT SITE ADDRESS: STREIr qQLV OV*!✓1 b PARCEL.#: Q01+11582102100 CRY STATE SUITF.IUNIT #c FLOOR #: ADDrrIONAL LOCATION INFORMATION (if applicable):. TENANTBUSINESS NAME (if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: lot No.: (attach copy of long legal description) s CGNTAC NFORMAT ONy r - OWNER NAME: yk r C eJ OWNER MAILING ADDRESS: STREET "h P<Vb CITY ew*tAt STATE W fit 21P OWNER PHONE: Q ' 2 OWNER EMAIL: (� - CONTRACTOR COMPANY NAME: t�Vl p) t r WA STATE CONTRACTOR LICENSE #(REQUIRED): E7H AN 41 9 34 P g CITY OF EVERETT 13USINESS LICENSE #(REQUIRED). J ZZ CONTRACTOR ADDRESS: STREET CRY STATE 2P CONTRACTOR PHONE: CONTRACTOR EMAIL. PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR XOTHER (Please Specify) CO TACT NAME: l� I Vf t Y 1 CONTACT PHONE: CONTACT EMAIL: �- S <,:� �,,.... , .> '�� '..:�,,��BUILDING INFORM/►TION � z � � ��,� � e`" � � � �,� VALUATION OF WORK: $ klsh000 ASSOCIATED LAND USE PROJECT #(if applicable): (Vaivalion shallinclude'the:prevaiiing fairmadcetvalue of all labor, materials —and equipment needed to complete the worK .whethecactualypaid or now EXISTING USE OF BUILDING: S PROPOSED USE OF BUILDING: S HEAT SOURCE: ❑Gas g Electric ❑Other BUILDING TYPE; ASFR ❑Townhouse []Duplex❑ADU ❑Multi -Family- #Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Audition MRemodel ❑Repair ❑T.I. ❑Change of Use []Modular ❑Portable ❑Re -roof QExteriorAlteration ❑Tank (aboveground) ❑Accessorystructure []Fence over 7ft high ❑RackStorage []POOI/HOt Tub ❑Tank (above ground) ❑Other. DESCRIPTION OF WORK: MAY 0 6 2024 CITY OF EVERETT Permit Services ACKNOWLEDGEMENT.• I have reviewed this application and confirm the information contained herein is true and coffect Work done pursuant to this permit must comply with currant fodaral, atata, and focal law. Thu gran" of a permit ohfy authorfzea appravod war* and no dor dibna thcrs6vm. DaWafiona must That he euthmized In waffing hum h e Building Official before being authorized underany circumstance. T am the owner, or 1 am.author&ed by the ,ownerofthis 'pmpedy to perform the work for which application is made, and I comply with the State Contactors Law 18 27RCW and 298 2d0A WAC City of EverettOffrclal Use Only or)� V �j M PERMIT # . ierlAuthorizedAge t ignature Date (Revised .412112022)