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PERMIl' APPLICATIO <br />BUILDIfvMECHANICAL / PLUMBING / SIGN 1 RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />� 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 />: <br />,.: _ <br />OJECT SITE ADDRESS: Lc� �j �-, �; iv�__ •.�,� PROPERTY TAX #: <br />for new construction: Short PlaVsubdivisi <br />OWNER NAME: � �� -��' <br />OWNER MAILING ADDRESS: sTREEr 2`/ Z-� <br />OWNER PHONE: <br />CONTRACTORNAME: <br />CONTRACTOR ADDRESS: <br />CONTRACTORPHONE: <br />CONTRACTOR LICENSE #(FtEQUI <br />PRIMARY CONTACT: ❑ OWNER <br />CONTACT NAME: <br />Ex�sting Use of Building <br />cilv <br />%�L , ✓r L <br />STREET <br />Lot No. (attach copy of long legal description) <br />�y�oRmaTroN <br />TENANT NAME (If Commercial): <br />OWNER EMAIL: <br />STATE <br />ZIP <br />CITY `Y l G� (/' � I'�. w� l D�� v STATE ZIP <br />CONTRACTOR EMAIL: ULti ?�S �(' C�-S - <br />RED): (/J��— �/v �`"/�G- �L'CJ CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): OS <br />TRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: <br />/ CONTACT EMAIL: <br />Proposed Use of ilding: <br />Buiiding Type: SFR-Detached ❑SFR-Attached <br />Type of Project: ❑New ❑Addition ❑Remodel � <br />DESCRIPTION OF WORK: <br />/���� -F %�,�/�, �-���r-�/ <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />.DING PERIVIIT APPLICATION ' <br />Contract Price of Work: $ 5��� <br />Heat Source: ❑Gas ❑Electric ❑Other <br />�[Suplex ❑Multi-Family-# of Units: ClCommercial ❑Industrial <br />eoair ❑T.I. ❑Sign �Sprinkler ClDemolition _❑Change of Use <br />t����-r�= �x�s�;�f ���,� � z-,�s.��, �� �v�;� ;� y��.,, <br />�C',•'{'Y1�I�IG ((� �-�•��'v��/ iLpu^'r_ <br />ACKNOWLEDGEMENT.' I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant fo this permit must comply witlt <br />current federal, state, and /ocal law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviatia�s must first be authorized in writing from the <br />Building Official before being authorized under any circumsiance. 1 am the owner, or ! am authorized by fhe owner of tl�is properly to perform the work for which application is made, <br />and I compty with the Stafe Cont�actors Law 18,27 RCW and 296.200A WAC. <br />City of Everetf Official Use Only <br />_ PERMIT # <br />�� � � � �a,�-o5� <br />Owner/A o� en igna ure Date (Revrsed 10/12/20i5J <br />��� r�'� <br />