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Em 4ir . <br />In PERMIT APPLICATIOP <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everetiwa.gov 1 www.everetiwa.gov/permits <br />(Blase ®r Black Ink only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS:: ..- <br />G � i_t, ei r"L PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />_ CONTACT INFORMATION <br />OWNER NAME. C% /�/f ' fly L 57'/ l% C TENANT BUSINESS NAME Commercial): ;> <br />_ t /fir ?,4,.. �-J 'p r- <br />OWNER MAILING ADDRESS: <br />ER PHONE: <br />STREETX (i / 1,9 //L: <br />C(TY fL STATE �p �' <br />OWNER EMAIL: C �'� k j.J�G — iyl • �+ <br />CONTRACTOR NAME: ,�'✓ x� Ce& . sz 4c- - <br />CONTRACTOR ADDRESS: STREET . ' r <br />cnv ' 9 t a STATE zip - <br />CONTRACTOR PHONE: — - �' �� CONTRACTOR EMAIL: '� <br />CONTRACTOR LICENSE #(REQUIRED) : {? "/Z / lvc c� .- CITY OF EVERETT BUSINESS LICENSE #{REQUIREO): ? <br />PRIMARY CONTACT: ❑ OWNEf2 qCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE:R57 <br />CONTACT EMAIL: <br />,Z1,If-2.Lje7G/csa,}.��✓L5%Cva�.fc,a� <br />BUILDING INFORMATION <br />isting Use of Building: Contract Price of Work: <br />posed Use of Building: Heat Source: OGas ElElechic DOther <br />ILDING USE: OSFR OTownhouse ODuplex OADU WMulti-Family # Units <br />.,;Z,14;_ ❑Commercial OAccessory Structure <br />pe of Project. ONew OAddIUOn ❑Remodel ❑Repair OT.I. OSign OSprinkier ❑Demolition ❑Change of Use <br />:SCRlPTION OF WORK: P—e-100L.,•C' 0/41 <br />/� �p/l� %�/7` 7-24// /L J ��;; ri 'fit' <br />SOCIATED BUILDING PERMIT # (if applicable): �C' �;�i° 6k r — a%1 AX S7 D� F .AD,c �. r <br />- - - - - rr. o�, • • o,,,. au„snn ate rnrarmauon 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 bafore being aufho,7zed 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, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PER e2 2- - <br />cA r ?, <br />(Revised 1011012018) \ 1/ <br />