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• • ���`� <br />PE T� ��u� � <br />RMIT APPLICA ON <br />BUILDING I MECHANICAL / PLUMBING ! SIGN / SPRINKLER / DEMOLITiON <br />GITY OF EVERF_TT PERMIT SERVICES <br />3200 CEDAR SI REET, EVERETT, WA 98201 <br />(P) 425-257-fl810 j FAX 425-257-8857 ((E) everetteps@everettwa.gov � www,everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />OJECT SITE ADDRESS: 12D 8���� PROPERTY TAX #- <br />.4v� Ob �/ b zzGo/ o� <br />3AL for new construction Short Platlsuodivision ue� m Lot No (attach copy of long legal description) <br />ER NAME: �j�}- � <br />ER MAILING ADDRESS <br />ER PHONE: <br />NTRACTOR NAME � <br />NTRACTOR ADDRESS <br />�--�� v�� <br />. STR[ET J <br />c�n <br />_ .�"'r3.� � <br />CONTACT INFORMATION <br />Q-(}Y TENANT NAME (I <br />Oh' �,uu�a-�- G�,c�i,�u.c.¢. <br />$�iRE�ET r�% <br />c:�n +es,a� <br />F2ACTOR PHONE: ''�"H�'c'S" —O <br />RACTQFi LICENSE #tREC�U1f�EiJp: �le/ <br />4RY CONTACT: ❑ OWNER �(lh!" <br />ACT NAME: <br />r� �4-d t� /)')1 �E�2. <br />Existin Use of B�slldin �g' <br />Psoposed Use of Ei�aiidin �/ <br />Bu�iciin� Type OSFR-Detached L�R-Attache <br />Type of Praject ❑New ❑Addition ❑Remodel <br />DE3CRtPTION OF WORK: <br />� <br />EMAIL: <br />Commercial): <br />sr,�rE� cc�i'�- <br />r.7 !su[c5�n.�[.+�tS%+D <br />. �cf'�do / <br />. Lgyr.i <br />� � �H' /alA- <br />:,-,,-E �,4 >�f> 9�/a2 <br />CONTRACTOR EMAIL: �S�a �' ' �'� <br />d,d,..s.� CITY OF EVERETT BUSINESS LICENSE'rt(fiEQEJIR���: D 3�y�p <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: �� � "�8(� _ ��..r� <br />CONTACT EMAIL: ..�. _ �.� � �.�,,.._.. �.r1r, <br />BUILDING PERMIT APPLICATION <br />%+-eS�-��. Goniract Price of Work: $ i .�� <br />Neaf Source: ❑Gas ❑Electric ❑C�ther <br />d ❑Dupl�x ❑Mtrlti-�ainiiy•# of Units ❑Commerciai ❑Industrial <br />Ir�f�'epair ❑T I ❑Siqn ❑Spnnkler ❑Demolition ❑Ch�nqe of Use �e <br />�rn� �.r„�� ��,.L� �s+�- � W� ��� � �- °� J �- ��. <br />�, <br />A55�CIATED BUILDING PERMIT # (if appl�cabie) �`'K� �� `� �� � <br />ACKNOWLEDGEMENT ! have �eviewed this application and confirm the rnfarmation contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and tocal iaw ihe granting of a permit onty authorizes approved work and no deviations there/rom Deviafions mus! firsf be authorized in writing from the <br />8uild�ng OIlicial before being authorized under any c�rcumstance ! am the owner, or I am authonied by the owner of this property to pedorm the work for whrch application is made. <br />and 1 comply wifh the Stafe Contractors Law 18 27 RCW and 296.200A WAC <br />Cify of Everett Olficial Use Only <br />PERMIT � <br />�,�'n,i.,.�,,.�- 'y�'7�'�'.al (� � <br />OmiettAutharized Agent S'sgnature C7at4 {Revrsad tOlt.r?bt5) <br />