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� PIERMIT AP6'LICATIO� <br />BIJILDINC7 / iV1ECHANICAL. I PLUiVIBING I 51GN �� RIiVKLER / D�IViOL.ITION <br />CITY OF EVERETT PERMI7 SERVICES <br />E 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetfeps@everettwa.gov � www.everettwa.gov/permits <br />,:. _ - - <br />- ,: , <br />,. <br />' .___ PROJEC'T SIY�.INF.ORMATION.. :: . <br />_ : :.: _ <br />�JECT SITE ADDRE� � � � PROPERTY TAX #: ��.�� �, �? 'v '3 � �,> O <br />� � -.} <br />�AL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: S��YL-i � C-�i ����`�}' <br />OWNER MAILING ADDRESS: � �r�e� S �� /�%` <br />CITY � C,� �` �7 � <br />OWNER PHONE: �'U �O �� ��{ C.� ��� S� <br />CONTRACTOR NAME; � �J � L�� �� L—� n-- <br />CONTRACTOR ADDRESS: srReEr <br />CIIY <br />CONTRACTOR PHONE: � � � � � � �` � � � <br />CONTRACTOR LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR <br />CONTACT NAME: <br />TENANT NAME (If Commercial): <br />S� <br />OWNER <br />STATE �N � <br />c � n �i ►vl.C'� n j <br />.. <br />STATE <br />CONTRACTOR EMAIL: <br />CITY OF EVERETT BUSINESS LICENSE <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />ZIP �j � �/�-�� <br />� <br />� c�t,ti) • ��uV� <br />ZIP <br />RED): <br />Existing Use of Building: Contract Price of Work: $ <br />Proposed Use of Building� Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New C7Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Qemofition ❑Change of Use <br />DESCRIPTION OF WORK:, <br />`�.e LL, �� f l�-f z� Li�� <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />ACKNOWLEDGEMEN7.• ! have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and locallaw. The granting of a permit only authorizes approved work and no deviations fherefrom. Deviations must first be authorized in writing from the <br />Building Official before berng author' �1 under any circumstance. I am the owner, or I am authorized by the owner of this property to perform fhe work for which application is made, <br />and I comply wifh the State Co � w 1 B.27 RCW and 296.200A WAC. <br />� City of Everetf Official Use Only <br />PERMIT # <br />�, � � �� � ��- � �� � f - ��- �� � <br />Owner/Author¢e Signature Date (Revised 10/1212015) <br />c/✓ ) �� <br />/ `% <br />