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• <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN 1 SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />tM A9K.7Ii7.AA1n 15AX425-257 8857 I (F) everettens0)avereffwa.nnv I wwweveraffwa.nnv/nermffs <br />ROJECT SITE; ADDRESS: (e'?0'7 +.l <br />IL <br />PROPERTYTAX#EGAL <br />for new construction: Short Plat/subdlvlsion <br />Lot No, (attach copy of tong legal description) <br />OWNER NAME: " (,U e <br />TENANT NAME (If Commercial): <br />OWNER MAILINGADDRESS: STREET 2� <br />60) <br />�.,���p.�•IOl7 <br />CRY vNv�n+ <br />{ STATE to ZIP <br />OWNER PHONE: �j i Q�i�i S�D <br />OWNER EMAIL: U . VP�/?A IrOv <br />CONTRACTOR NAME: CVC-Ka Aj '57`4-7-1" -! tiqCCrP46TA-c' <br />CONTRACTOR ADDRESS: STREET °2-I 9-10 Ar, A0 9- <br />CITY l V�yc. STATE WA-- ZIP IGOO <br />CONTRACTOR PHONE: `Z�✓ �`�g'� P� j T CONTRACTOR EMAIL: wA . GIm <br />CONTRACTOR LICENSE #(REQUIRED); CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 6 <br />PRIMARY CONTACT: ❑ OWNER IkCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE; <br />µ P Nd CONTACT EMAIL: µikL <br />' %13UILD1M <br />Existing Use of Building: Q � �4h�'�'!� 1 Contract PrIce of Work: $ �i <br />Proposed Use of Building: dejo b-AHeat Source: LJGas WElectric ❑Other <br />Building Type• ❑SFR Detached CISFR-Affached ODuplex ENultt-Family-# of Units: Wommerclal ❑Industrial <br />Type of Project: LJNew ❑Addition ORemodel ®Repair CIT.I, EISIgn ❑Sprinkler L7Demolitlon ❑Change of Use <br />DESCRIPTION OF WORK: <br />RoA DI) IF t 4f( <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />• . f1t1�Cr�A.E�liC�1,L I��RM9T' ���'kl(��°>�'�®k�' <br />rype of Project: _,New Addn Alteration _)t_ Repair <br />Of <br />Fixtures List ofF/xtures F/xfures LlstofFlxtures <br />A/C - Air Handlina Units I 1 Heat Pump <br />Heater <br />ACKNOWLEDGEMENT.• / have reviewed this application and confirm the Information contained herein Is true and correct. Work done pursuentto this permltmust comply with <br />current federal, state, and locallaw, The granting of permltonly authorizes approved work and no deviations therefrom, Devlafions must first be authorized In writing from the <br />Building Okla/before being authorized under any circumstance. l am the owner, or am authorized by the owner of this property to perform the work for which application Is made, <br />and l comply with the State Contractors Law 98,27RCWand 296.200A WAG. <br />City of Everett Official Use Only <br />PER T# <br />o(27/so <br />Dwner/Authbrized AfLntSignature Date (Re visa d 512012016) <br />