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PERMIT APPLICATION <br />BUILDIN�IIECHANICAL 1 PLUMBING / SIGN /�21NKLER / 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 1NFORMATI:ON ' <br />, <br />PROJECT SITE ADD SS: ,�-r-- PROPERTY TAX #: , <br />j L� L' S�' j� 1! /�� c°' �/�=�(J <br />�,,r>�T_T i�� 5 / <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />' ' ` CONTACT INFORMATION . <br />OWNER NAME� ��b� Z1 l�lf q lltiy�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReer /�' �,� / ��� r� � S� <br />ciTv <br />ER PHONE: <br />ONTRACTOR NAME; �iply[�-- <br />ONTRACTOR ADDRESS: srReer <br />�OWNER EMAIL: <br />_ . _ . _. <br />, �dd�s "fr�u��rc� <br />� s � i3�,,� % � �-' � <br />E_ <br />STATE G�.2�i Z�P <br />CITY G� .. .��I� l S� STATE GV i�v'� ZIP <br />ONTRACTOR PHONE: ��" " Z � �-��-� S CONTRACTOR EMAIL: %ij v�•�..z �'�� � �� � <br />ONTRACTOR LICENSE #(REQUIRED : 41� �� C--,� ��5 IJ � CITY OF EVERETT BUSINESS LICENSE #(REQUIRE <br />RIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />ONTACT NAME: CONTACT PHONE: �/��— � - �� � � <br />� V ( � s. `l '' / �� L1 ' CONTACT EMAIL: �„�C%,,,� � Q%�,� :sJ�+ , • �r(,�/' <br />.�,^ ( <br />' ' v BUILDING PERMIT APPLICATION <br />,. _, <br />•; � • t;�-�-��� 1u"_� � Contract Price of Work• $ %� ��pG3 <br />Existing Use of Buiiding: C ..�. <br />Proposed Use of Building: I� G;, ,%�L�� Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached L Dupiex ❑Multi-Family�# of Units: ❑Commercial ❑Industrial <br />Type of Project ❑New ❑Addition ❑Remodel Repair �T I C]Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: 1�, � <br />'��, t'� G� i ✓' k�' � E> � `J �4'` i�--"l i.c.-L"�= �� (r4.,E� � `� '�1�'-��- � 'l ��1 <br />vl 1 <br />b l� G�1 �� �a�-E. �, <br />ASSOCIATED BUILDING PERMIT # (if applicable): _ <br />ACKNOWLEDGEMENT. I have reviewed this applrcation and confirm the information contained herein is true and correct. Work done pursuant to this permit musf comp/y with <br />current federal, state, and local law. The granting of a permit only authorrzes app�oved work and no deviations therefrom. Deviations must first be authorized in writing (�om the <br />Building Official before being authorized under any circumstance. I am the owner, or I am aufhorized by the owner of this property to perform fhe work for whrch application is made, <br />and I comply wifh the Stafe Contractors Law 18, 27 RCW and 296.200A WAC. <br />F City of Everett Official Use Only <br />C� �i��`�� .� J l � 4� PERMIT # � I�G'� ��G�� Y' <br />_, l <br />Owner uthor' ed Agent Signature Date (Revised 10/12/2015J � <br />ti � <br />