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PERMIT APPLICATION� <br />BUILDIN � ECHANICAL / PLUMBING / SIGN I?!!�RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />E 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT:SITE INFORMATION - <br />'ROJE�,T�T a�C�QRES�� C � �� z PROPERTY TAX #: � � .7, � ,. <br />Cn `�i � G. `3 rT—� i � �'> 'l <br />_EGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTAGT'INFORMATION ! <br />R NAM E: Q;�j �. t--�„ 1 �� <br />��—� <br />R MAILING ADDRESS <br />STREET <br />r Ll�ii�=%L� TENANT NAME (If Commerc <br />CITY �� �1 1��-� �` <br />PHONE: "T�'� � i ( C � <br />RACTOR NAME: �_��,. <br />RACTOR ADDRESS: sTReeT <br />C ITY <br />OWNER EMAIL: <br />STATE <br />STATE <br />ZIP <br />ZIP <br />VTRACTOR PHONE: �,� ,. CONTRACTOR EMAIL: ,:.� " <br />VTRACTOR LICENSE #(REQUIRED): ��j�`�� �Z,S' ���`j^�, CITY OF EVE ETT BUSINESS LICENSE #(REQUIRE <br />MARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />VTACT NAME: ���� ������„�� CONTACT PHONE:� _3�, � S <br />CONTACT EMAIL: ,.e.. __/ „'� ,,, (� � _._ _ __ �. -.. ,, .� <br />' BUILDING PERMIT APPLICATION <br />Existing Use of Building: c�— Contract Price of Work: <br />Proposed Use of Building: t� Heat Source: ❑Gas <br />Building Type: ❑SFR-Detached �1SFR-Attached ❑Duplex ❑Muiti-Family-# of Units:_ <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler <br />DESCRIPTION OF WORK: ���� � ��� ✓ `�� t� _`� � � �� <br />�— � -�r�. <br />-� @4 �'l � � t �F-f� �, �Svi� �L">�-'�.. 1 <br />AS50CIATED BUILDING PERMIT # (if applicable): _ <br />�_�, 44�'�•;" <br />❑Electric ❑Other <br />❑Commercial ❑Industrial <br />❑Demolition ❑Change of Use <br />���� ���c�� <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 wfth <br />current federal, state, and local /aw. The granting of a permit only authorizes approved work and no deviations therefiom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to pertorm the work for which application is made, <br />and I r.�m�lv with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />(-D�( <br />(Revised 10/12/2015) � <br />� � <br />� <br />