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� PERMIT APPLICATION <br />BUILDINC��TiIIECHANICAL / PLUMBING / SIGN I, r21NKLER / 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 />ROJECT SITE ADDRESS:_ ^ j , - PROPERTY TAX #: <br />7 J�-- �'it �'� v' <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />, , C NTAGT INFORMATION <br />ER NAME: �' j,biCl <br />ER MAILING ADDRESS <br />ER PHONE: <br />ONTRACTOR NAME; �_ <br />ONTRACTOR ADDRESS: <br />CONTRACTOR PHONE: '�'J <br />CONTRACTOR LICENSE #(REQU' <br />PRIMARY CONTACT: ❑ OWNE <br />CON�ACT NAME: <br />�7��1E`L�.l�l.�7 - �-G!� <br />STREET <br />CITY , <br />STREET <br />cirr <br />� � <br />�, �, TENANT NAME (If Commercial): ���� �`� <br />� C.� �kt . E%C . . - <br />STATE <br />OWNER EMAIL: <br />c <br />. L/ �X-� / ��� <br />\X- <br />STATE <br />(l`� /�:1 J�— CONTRACTOR EMAIL: �`1Lr'GC:'�1•� C J��l <br />�5 �L_ (i �� � CITY OF EVERETT BUSINESS LICENSE <br />;ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: � � — � �,� ' E <br />CONTACT EMAIL: � �t �,(,�i,�j. � 4 (`t � <br />ZIP <br />ZIP �,/• <br />:C�%1.�, � <br />UIRED): �l <br />�— <br />� <br />JE� 1�'zJ, <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: - 7 �ti`l G�'I% �- �`�`� 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 Pro'ect: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n OSprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: -; , ,� <br />, � , � 7 ; l � L� r `�?�,''� � �(�- 1/� <br />� , � ��t fC �� �� _� G'V�. <br />�r�l.G�l�`� l� `�� <br />� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />ACKNOWLEDGEMENT. 1 have reviewed this <br />current federal, state, and local law. The gr <br />Building Official before being authorized u de <br />and / com ! w the Sta Contractors aw <br />r'� 4� ✓� � <br />rized <br />3pplicatio and confirm the information contained herein is true and correct. Work done pursuant to tnis perm�r musr compry wirn <br />�g of a p rmit only authorizes approved work and no deviations therefrom. Deviations must tirst be authorized in wrifing from the <br />any circ rnsfance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />3.27 R and 296.200A WAC. <br />�7 Ciry of Everett Official Use Only <br />PERMIT # <br />t ,�; ��- ,l�i � �' C�� - US l <br />Date (Revised 10/12/2015) <br />