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BL-_DING PERMIT APPLICATIG_. <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 /> 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((W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET U W VW N I Z(o `0 0 56 Sfis ARCEL#: r)Q %) . <br /> CrrY '"�( ' STATE K,l.'S zip 96 4 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): qAkC rc`"1, _ pzr.. <br /> el <br /> TENANTIBUSINESS NAME(if non-residential): <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: AN G fiC '~ `c t <br /> Lot No.: (attach copy of long legal description) <br /> ) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'E <br /> OWNER MAILING ADDRESS: STREET C E3C• <br /> CnY i �E t_4'� STATEWA ZIP '7 <br /> OWNER PHONE: OWNER EMAIL: f/�VEj_(::,PAf1 A <br /> CONTRACTOR COMPANY NAME: LEA )IV <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 2� i <br /> CONTRACTOR ADDRESS: STREET ?C- S <br /> CITY 1"L iIE?�S STATE w.�" Zp 0 S 5 <br /> CONTRACTOR PHONE: LaZ5-L.0 S,—7 Z j&-'� CONTRACTOR EMAIL: �2 • 'CL,&O/-)Ga mlry �/ f <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Q OTHER(Please Specify) r"ij t L_ ENI—I I EEK <br /> CONTACT NAME: <br /> ENPOACTPHONE - C, �2-YT .F ; ONTACT EMAIL: <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$ GLp f ; ASSOCIATED LAND USE PROJECT#(if applicable): reev t ZZ —02 2 <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING: <br /> HEAT SOURCE: ❑GasElectric ❑Other <br /> BUILDING TYPE: PSFR ❑Townhouse ❑Duplex ❑ADU []Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ' 1New Construction ❑Addition ❑Remodel ❑Repair ❑T.L ❑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: <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.I am the owner.or/am authorized by the owner of this property to perform the work for which application is made, <br /> end i comply with the state Contractors Law 76.27 RGW and 296.200A WAC_ <br /> City of Everett Official Use Only <br /> PERMIT# <br /> c�C CCi� s-Cr�J �f1(e14 <br /> Oxmer/Autho" d Agent Signature Date (Revised 4/21/2022) <br /> 1/7 <br />