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\ I ASSETS Loft E V BUILDING PERMIT APPLICATION E R E CITY OF EVERETT PERMIT SERVICES required for review, WAs"I IN N 7 SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies r i gox. TN then dropoff completed application plus all required submittal documents to 3200 Cedar Street 2ndoV looms intake Drop (Blue CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov (W)everettwa.g Pe or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS. (,f PARCEL#: 1 0 X STREET Q STATE U '>• ZIP SUITE/U crrr �' NIT#; FLOOR#: �- ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): of long legal description) LEGAL DESCRIPTION for new construction: Short PlaVsubdivision: Lot No.: (attach copy CONTACT INFORMATION OWNER NAME: l_l. OWNER MAILING ADDRESS: srREEr � •ZO � Jt.-_ CITY STATE ZIP OWNER PHONE: 2ig OWNER EMAIL: W t` CONTRACTOR COMPANY NAME: L LPL WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CQ CONTRACTOR ADDRESS: STREET 8 Zo toc— ? �^ � !x, My STATE ZIP �J u CONTRACTOR PHONE: ZQp.�'�,�L 41 CONTRACTOR EMAIL: PRIMARY CONTACT: [OWE N'IE.R 'G CONTRACTOR El OTHER(Please Specify) CONTACT NAME: A t CJ CONTACT PHONE: ��•�� .OL CONTACT EMAIL: BUILDING INFORMATION VALUATION OF WORK:$ 2-to, ASSOCIATED LAND USE PROJECT# if applicable): (valuation shall include the prevailing fah ma et value of all labor,materials,and equipment needed to complete the work,whether actualy paid or not.) EXISTING USE OF BUILDING: T y� st- PROPOSED USE OF BUILDING: HEAT SOURCE: Gas Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all f t apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use []Modular ❑Portable Re-roof El Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 31z�� Owne!Author d Agent Signature Date (Revised 412 112 0 2 2)