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I'ERiVIIT ,4PPLIC,�7(O
<br />BUIL.DIN�ECMA.NI��,L I PLlJ�l1�IRIG / SIG ,PRI1VaCL�R / DEi11��L.ITION
<br />CITY OF EVERETT PERMIT SERVICES
<br />3200 CEDAR STREET, EVERETT, WA 98201
<br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@evereftwa.gov � www.everetiwa.gov/permits
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<br />; . , - PROJEC.T �IY� IIVFORM,�T10N ; ,. -
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<br />PROJECT S1TE ADDRESS: PROPERTY 7AX #:
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<br />LEGAL for new construction: Short Plat/subdivision Lot No. (aftach copy of long Iegal descripiion)
<br />- CONTACT. INFORMATION ,
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<br />OWNER NAME: ��,� ( �r, .�.V� TENANT NAME (If Commercial):
<br />OWNER MAILWG ADDRESS: sTReEr `-�U�I �,� S=c � ��--
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<br />CIN L� V��Y- � STATE (;'V�(�- ZIP ( U z b �
<br />OWNER PHONE: OWNER EMAIL: c�� G�'`J� �� C'��/�'1 C��1�%�"� t
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<br />CONTRACTORNAME; ECnn�r���c j.l�r�� !✓�c .r}vi� R��^ ���-����'lOv�'�., (�L-�
<br />CONTRACTOR ADDRESS: sTReET �\ C>� }�^ A t�'� �� �� � Y'S
<br />CITY � U e � � ` ' STATE � � ZIP 'S � �' C�
<br />CONTRACTOR PHONE: ' (�C� - ,Cj�-��- �Z �� CONTRACTOR EMAIL: /C�rl =� � �`:-� c �v�� c:.. Inc���'�� • L��Y�
<br />CONTRACTOR LICENSE #(REQUIRED): E'c�/�1 �i-t �- ��"'� 3i�' \ CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):
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<br />PRIMARY CONTACT: ❑ OWNER �ONTRACTOR ❑ OTHER (Piease 5pecify)
<br />COIVTACT NAME: CONTACT PHONE: G{ZS .- ,-`�� �� �i —��'t' 3y
<br />I��'�✓�. ��L'"�� L,V� CONTACT EMAIL: �v'1 t:e: �CG�'7L;r� i L�lG-=Q ,^c1f- . Lc'>� v�
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<br />BUILDING PERMIT APPLICATION` _
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<br />Exisfing Use of Building: Contract Price of Work: $ �� ��� ���
<br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial
<br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑5prinkler ❑Demolition ❑Change of Use
<br />DESCRIPTION OF WORK:
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<br />i/�� ��� �I; I, ���' ,. F"I, �� 6 110i,����
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<br />ASSOCIATED BUILDING PERMIT # (if applicable):
<br />ACKNOWLEDGEMENT.� 1 have reviewed this application and confirm the informafion coniained herein is true and correcf. Work done pursuant to this permit must comply wifh
<br />currenf federal, state, and local law. The granting of a permit only authonzes approved woik and no deviations therefrom. Deviations must first be authorized in writing frorn the
<br />euilding Otficial before being authorized under any circumstance. I am the owner, or! am authonzed by the owner of this property to perform fhe work for which applicatron is made,
<br />and l comply with the State Contractors Law 98.27 RCW and 296.200A WAC.
<br />Cify of Evereft Official Use Only
<br />PERMIT#,l,\ I� r, � J r` ` I�
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<br />Owner/Aut orize Agenf Signature ate (Revised �0/9y20i5)
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