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PERMIT APPLICA7 <br />BUILDS / MECHANICAL / PLUMBING / SI = SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov ( www.everettwa.gov/permits <br />PROJECT SITE ADDRESS: +D & f l� K1 "� v E PROPERTY TAX M O OUCH CD <br />LEGAL for new construction: Short Plat/subdivisiony CE\r/ \Of �t A DC> Lot No.--4-9 (attach copy of long legal description) <br />OWNER NAME: ? \ ? t ENANT NAME (if Commercial): N A <br />OWNER MAILING ADDRESS: STREET %0 (y I <br />CITY �V�'Q£ STATE ZIP 'L(� <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: 1CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT. ❑ OWNER ❑ CONTRACTOR LAOTHER (Please Specify) &P—yAx-r ">j2�" t L.rcS <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL:. -- <br />Existing Use of Building: 1 Contract Price of Work: $ <br />Proposed Use of Building: c�� Heat Source: as ie- ❑Other <br />Building Type: ❑SFR-Detached SFR-Attached []Duplex ❑Multi -Family-# of Units: ❑Commercial [Industrial <br />Type of Project: ❑New ffAddition UXRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: SZENwA�tol`1 L�(- �><��T\NC� 5�2. p�pp p� L�r�,ent�tG w J L1VINt� <br />S9k-c7 hpACE '1—HA*r 111,)Cl0PAS <br />'eAm+. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <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 federai, 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 Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # 61(0- <br />I I <br />(Revised 5/20/2016) t <br />