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BUILDING PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklistfor 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)PemnitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1424 Maple St PARCEL#: 004387-280-021 <br /> clTy Everett STATE WA zP 98201 <br /> SUITEIUNIT#: N/A FLOOR#: N/A ADDITIONAL LOCATION INFORMATION (if applicable)- <br /> TENANT/BUSINESS NAME(if non-residential):N/A <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/A Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Nathanael Coffing <br /> OWNER MAILING ADDRESS: STREET 3233 S bay dr <br /> CITY Serdo Woolley STATE WA zIP 98284 <br /> OWNER PHONE:206.399.0298 1OWNER EMAIL: ncoffing @gmail.com <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206.399.0298 <br /> Eduardo Piedra CONTACT EMAIL:piedra.eq@gmaii.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$4,000.00 ASSOCIATED LAND USE PROJECT* if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materiats,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:Residential <br /> PROPOSED USE OF BUILDING:Same <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:Replace drywall on the living room ceiling, a one foot section all the way around the <br /> same ceiling area. Repair drywall holes around the house because of plumbing and <br /> electrical work. Re-enforce framing for ceiling with 2x4 framing wood. <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./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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P IT# <br /> 7/25/22 <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />