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r�r ivur r OgETTHrruR.R i w <br /> BUILDI MECHANICAL/ PLUMBING/SIC PRINKLER/DEMOLITION <br /> II CITY OF EVERETT PERMIT SERVICI <br /> 3200 CEDAR STREET,EVERETT,WA 9— <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3 Z z pi,,i 4., q 2-,01 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4s ._� ( TENANT NAME(If Commercial): ;i , y, ,r <br /> OWNER MAILING ADDRESS: STREET 97) fi , <i tP <br /> CITY �; STATE ZIP h <br /> OWNER PHONE: v q /. v OWNER EMAIL: 5icoai,:r r eD ? coy,- <br /> CONTRACTOR <br /> orrCONTRACTOR NAME: S,e-7 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: Sri 3 -Sy/ J CONTRACTOR EMAIL: `cx.'7,, , ,4d6, torr' <br /> CONTRACTOR LICENSE#(REQUIRED): > CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: &we), t Contract Price of Work:$ <br /> Proposed Use of Building: » wry Heat Source: ,was ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 0Multi-Family4 of Units: LCornmercial ❑Industrial <br /> Type of Project: ❑New ❑Addition j5Rermodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ,.3J4 - <br /> �n (^.o'��� f+ y p Od�9 a_%a L(—) i =i?9 L• "dI57fc, 5/'A <br /> ? <br /> °-#P y -f �P✓ 604/2-2- A 5 u. <br /> d <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ' e:414" o ' v t '' C8"? <br />