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• P�RMIT APPLICATi�iV �
<br />BUILDiNG ! M��FIANICAL ! P�.UM�ilVG 1 SIGN t SPRiNKL.ER / DEIUIOl.ITIC7N
<br />crrY• oF �������rT ����nir s��vic�s
<br />3200 CEDAR Sl'REET, EVERETT, WA 98201
<br />(P) 425-257-8810 � FAX 425-257-$657 �{E) everetteps{�everettwa.gov � w�v�.everettwa.govJpermits
<br />�ROJ�C'�' �1"1"E IPiFt�RMATIUW
<br />PRCiJECT' S1iE AqDRESS. �r�.�-� � j- �:�� � i✓��, P�cr���rv -r� �: C�S� 302.5(�b tv�U
<br />LEGAL for neov construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br />�o��ra�-r r�v�v�r��ric�N
<br />OV{IWER NAhAE: ,���i �rj':�:.`.-a i:: .%'f�t�� f'�C ,�'ti�;�-t�s�C� TENAFdT NAME (if Commerciaf}:
<br />OWNER MRILING RDDRESS: sTreee�� �'• �. / i� �.�} '�'�',��`: ti-� tr ��' '
<br />a�Y �„'��'` � _ �rt.'�1' c'1 � ?.0 ;.`~y
<br />57i�TE ( 21P
<br />OWfVERPHONE: •%��/'1 -.%7� ?��:;.�� OWIV4EFtE1liiAll.. �.�1J1'i��`,�'i��6f: j �hL�_la J�'�' -��)�)s;3 t� ,(^�:�t'1"�
<br />-__�_.____.__ .w.._...._.�� __._...._.._.__��.._..----,.._._._,..__._.,..--��--•._,..
<br />CONTRACTCIR NAME: - ''; � r ' ____.__'�...�� ; .- _.------__�--- -
<br />CONTRACTOR ADDRESS: srHeE� ',� , t �;� i
<br />.�
<br />(I'IY ��''�i 'j�'�;' �`t STAY[ � /i..�. LIP r�: ��� >
<br />CONTRACTOR PHC}NE: ` . `� .3f ` __��CL��iRAC. , OFt EMAlL: ,, , t; . ,
<br />i ,. , ,
<br />CONTRACTOR LICE�ISE i#(REQUIi�ED): �' ,� i�����; ,,,� t; t�,��r CiTY QF EVERET'i' BUSINESS LlCEN5E #(RERUIRED�: t',� r-; -, :,`
<br />Pf21flAARY CQNTACT: �.�`pWNER CI GOhJTRACTCIR L7 C)TFiER (Plsase Specify)
<br />Ct7#V7ACT NA�E� co�arAc-r i�r�o��: �-2�"- Z �t-�1 -�"l �D
<br />��'7e5 %��c.15�e�c� CC;P�TACT EMAiL: �rj'rJ P�(,� if� r S!'��'CrC� �'�'JAf�, ��,�,
<br />�tJIL�tP1C'w ��R�iT 1�1F►�LiG�ilt}�
<br />Existin Use af Buildin >'1 ��
<br />9 9' ��>1� � •���`�r'�:.:j�iCi � Contract Price af Work: $ 0� C1 P� �
<br />Proposed lise of Buifdin � Hear_�ource ❑Gas ❑Electric �Qther ��� �
<br />Buildin Ty e: r FR-Detached OSFR-Atiached ❑Duplex �lMuiti-Family-# of Units: C(Commercial �industrial
<br />Type of Project: ❑New ClAddition ClRemodel C'�F2epair ❑T.i. D;3I� C7Sprinkler ClDemolition C�Change af Use
<br />DESCRIPTION pF WORK: ;�. : •� � ; "�l �', ' ' 1't �t'' � �` , . ' a .',' ' � (V ; r :�;J7?., �' y,�; i.'.S ; f rt _l .. .' .�'.,_1
<br />,,#�,� , t;a�f"'r�l rr,�Gc� /,l , �.,
<br />, '
<br />fc.:�ii �:,r'[�ty/�.:iaJr''.I'� % ,.tN l.::.I?i. . ., /` ,, a ? �t _� _! r' -y;a�,� l ' ,,., �,l
<br />�� '�; . .;� !il ,''�, �qr , Al. y� � t � '�„ e � t
<br />ASSOCIATED BUIL[71NGf PERAfliT # (if applicable):
<br />ACKNOWLEDGEMENT.� 1 have revieweU this application and confirm the informatron containad herein is true and co�rect. Work dona pursuant to thrs permrt must compty with
<br />cun�nf fede�al, state, and local law. The granting of a pe�mit oniy auFhonzes appraved work and no deviations therefrom. L�eviations musf first be authonzed in writing from ihe
<br />euiidin� Officia! before being authorized under any circumstarrce. f am ihe owner; or 1 am authonzed by 1he owner ot tt�rs property to per(orm the work tor w�hrch application is macte,
<br />and f comply wrth tl�e State Guntracto�s Le�v 18.27 RCW and 296.260A WAC.
<br />Cii}� cf Everett O�cia! Use Only
<br />PERMIT # O I � ��
<br />(f�evr.sed iC� 2/20�51
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