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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 <br /> PROJECT SITE ADDRESS: STREET 310 E.View Ridge Drive PARCEL#: <br /> cm Everett STATE WA ZIP 98203 <br /> SUITEWNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if nornresidential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Kirk and Cathy Bierman <br /> OWNER MAILING ADDRESS: STREET 310 E. View Ridge Drive <br /> cITY Everett STATE WA ZIP 98203 <br /> OWNER PHONE:425-343-6299 OWNER EMAIL: kebierman@gmail.com <br /> CONTRACTOR COMPANY NAME:vanderBeken Remodel and Repair LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):VAN DER*811 RD I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 55051 <br /> CONTRACTOR ADDRESS: STREET306 State Ave <br /> clTv Marysville STATE WA ZIP 98271 <br /> CONTRACTOR PHONE:425-408-2224 1CONTRACTOR EMAIL:Jason@vanderbeken-remodel.Com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-408-2224 <br /> Jason Taylor CONTACT EMAIL:Jason@vanderbeken-remodel.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $709, 34 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing V market value of all labor,mateiials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:Residential <br /> PROPOSED USE OF BUILDING:Residential <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) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Maip_F4e Drywall on <br /> Walls and Ceilings. Enlarge Master Bathroom Footprint, Re-design of Kitchen, Replace <br /> Front Entry Man Door, Install new Sliding Door to Patio, Install new French Doors to <br /> Patio. <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.1 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 rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE T# <br /> Own /Authorize Signature Date (Revised 412112022) <br />