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07/ia/20i6 THU 12:3� Fax a25 252 ifi66 CM xeating �pp2/002 <br />• PERMIT APPLICATIO� <br />BUILDING / MECNANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CrTY OF �VERETT PERMIT SERVICES <br />3200 CE�AR STREET, EVER�7T, WA 58201 <br />{P) 428-267-B810 � FAX 425-257-8667 �(E) evere.tteps�everettwa.gov � www.everellwa.gcv/permlte <br />i�.'�:,, .�, �.a .' �- � ���� l� -''��' °` �'' M� �.��"�' INRA�IH �' ';;''� , <br />� , <br />PROJECT SITE ADDRE38; PROPERTY TAX 0�; <br />L�t3AL for new oonatructlon: 9horl PlaUaubdlvlelon __ Lot No. (aflech copy of long legel deacrlption) <br />, ".1,: yV6'�� .piFy.��.,,�.,i i,'i'� 5�.���' '� '�.J1�. , <br />;;;�., ��;, : �-,: ;�,,,;�, . �. �' �c� `� � T" ��A K N � . . � , , . , <br />;,;: �,�. <br />OWNER NAME: � � ' ` - "' <br />OWNER MAILING ADDRFSS: <br />HR PHONE: <br />ONTRACTOR NAME; ( � <br />ONTRACT�R ADDR�SS: <br />CONTRAC70R PHONE; p <br />CONTRACTOR L10EN8� #(REouIF <br />PRIMARY CONTACT: ❑ OWNER <br />CONTACT NAM�; <br />�.J�� � � 1 1 <br />9TREET <br />CITY <br />87REET <br />CfTY <br />TENANT NAME (If CommerclaU; <br />9TATE <br />OWN�R EMAIL; <br />" 6TATE <br />� CONTRACTOR �MA{L; <br />���.Y^I CITY OF EVERETT BU81N�83 I.IC�N8� <br />NTRACTOR � OTHER (Please Bpecify) <br />CON7ACT PHON€: <br />CONTAQT�MAIL:(/►n�oppr � ,.,, <br />�.�:' �'„_ .. . <br />ziP <br />21P <br />Existin Use of �ufldin : Contrect Price of Work: $ �� ��� <br />Pro aeed Use of Buildln : Heat 5ource: ❑Ges ❑Electrlc ❑Other <br />Bulldin e: C78FR-Detached I]SFR•At#ached ❑Du lex ❑Multl-Femll -# of Unita; ❑Commercial Cllndustrlal <br />T e of Pro ect: ❑New �7Addltlon [aRelpodel ❑Rg elr ❑T.I� C181 n C75 rinkler ❑Demolltlon ❑Chen e of UsQ <br />DEBCF�[PTION O� WqRK: <br />�G� �{� ��p ti � .� � . �, �� . <br />ASSOCIATED BWLDINl3 PERMIT # (ff e,ppNaa� � (r�� � <br />,: �:R , �+���►r��:� �,� ����r���.'��i��,�.. ,r �v,�,:�� <br />Type oF ProJaal: N�w Addn _Alterption `Repolr <br />* �� ��at ol Flx�urea o� <br />Flz�urea Flxwrea L/s� of �lxturea <br />A/C -- Alr Nendllne llnllo ee+ o,...... <br />ae oryer fioo <br />e r: <br />acKnlowLEDOEM6NT.• I heva revlawed th/a app!lcetfon �Rd oonl7rm tha !n(ormet(orr oontelnrd hare/n le f�ti�e �rtd Cor�ct, Work dvna purauant fo thls Aerm/t muat eomply w/fA <br />ourrent fode�el, afete, end loCal laW. Tha pranlfnp ol e pe»rrlt oMy �uthorhes epproved work end �o devleflons fherelrorir. Dev�af/ons must �l�sf be aufhorized !n wrltrng from the <br />6u!!ding OitiCiB! beiors belnp eufhorized under qny Cl�'Cur118fAnce. / am tha eWnar, o� 1 dm aufhorl2ed by fha owner of fhls prope�ty lo pe�fo�m fhe work lor whlCh appflcellon !s made, <br />end 1 comply wlfh fhe S[ete Con�raofors I_aW 18,p7 RCW end 288,2p0A WAC. <br />Clly of Evgratt OfflClal U90 Only <br />PERMIT # <br />M 6 U�� �- U 3� <br />Rev sed 20 201 BJ <br />