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PERMIT APPLICATION <br />BUILDINC�ECHANICAL / PLUMBING / SIGN / �INKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetleps@everettwa,gov � www,everettwa.gov/permits <br />PROJECT SITE tNFORMATiON <br />LEGAL for new construction: Short PlaUsubdtvisian Lot No. (attach copy of long legal description) <br />CONTACT tNFORMATION <br />OWNER NAME: ���� "'G�,=',�,�` _[A'� TENANT NAME (If Commercfal); <br />� <br />OWtVER MAILING ADDRESS: srrxe�,�' ,�,.�,� { �� �� ; � <br />- a ( .-... ,e•�, <br />PHONE: <br />ONTRACTOR NAME; R <br />ONTRACTOR ADDRESS: <br />ciTv �.�'�-�`�.�`"[� <br />� � VY� � � OWNER EMAIL: <br />CONTRACTOR PHONE: �-�� <br />CON7RACi'fJR UCENSE #(F�EClUIF <br />PRIMARY CONTACT: ❑ OWNER <br />C+DMITACT NAME: <br />STREET <br />cirr " <br />ng Use of Butfdinc�: <br />>sed Use of Buildin�: <br />n.r�T�pe: ❑SFR-Detached� <br />of Project: ❑New �Addition <br />:RIPTION QF WflRK; <br />❑ Remodel ❑ <br />STATE <br />STATE <br />ZIP <br />ZIP ""`( -Z�� } `.""��� .' <br />CONTRACTOR EMAIL:Y 1� �' '��'C.� ����`�) � '� �� � --� <br />�� fp"� CiTI` OF EVERETT BUSINESS LICENSE #{REQUiRED)_ �.� � <br />❑ OTHER (Please Specify) <br />GC►NTA!GT PHONE: j� j t�� ����� �'�,, ,�-� <br />� �. <br />CfiM1iAGT EMAIL: 1�}�k 't,t .I.�-�'"$``� t-� G�*t`i ��^e�'"t�� i 1 t`"f -�'�.-�r �' , r r��t 4„ <br />LDING PERMIT APPLICATION <br />�..�. ,,,,,� <br />Contract Price of Work: <br />Heat Source: ❑Gas <br />7Duplex ❑Multi-Family-#of Units: <br />�ecr�ir ❑T.L 05ian 05nrinkler <br />. � . --> � Sz.. �.��-��tC. -��Y��� <br />AS50CtATED BUILDING PERMIT # (if aQolicablel: <br />,�tectric ❑Other <br />C� � <br />❑Commercial ❑Industrial <br />❑Demolition ❑Chanae of Use <br />ACKNOWLEDGEMENT: I have reviewed fhis applica�ion and confirm the inlormation contained hereln is frue and correct. Work done pursuant to fhis permit must comply wrth <br />current federal, state, and local law. The granfing of a permit only author�ies epproved work and rto deviations therelrom. Deviations must first be aufhorized in wrifing Irom the <br />Building O(licial be%re being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work lor which application is made, <br />and I comply with the Sfate Contractors La 1&.27 RCW and 296.200A WAC. <br />� City ol Everett OKicial Use Only <br />�, PERMI O O <br />� <br />t <br />OwnerlAuthorized Agent Sfgnature ate (Rewrsed fQ! 2f2t715) <br />