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PERMIT APPLICATIO <br />BUILDIN ECHANICAL / PLUMBING / SIGN / RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ,� I�,; � � k�.�, °� �� � C'C; � PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �'�� f���� ���� �(��/c I Z� TENANT NAME (If Commercial): �'� sL -,� �; Or �G t_ ,,� <br />OWNER MAILING ADDRESS: srReeT <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME; � j, , � N, � <br />CONTRACTOR ADDRESS: srReeT ��� ,j'(j� �j���,�� �/ f i,l, �'L' <br />CITY � l� �S k STATE ,/� ZIP �(J�� <br />CONTRACTOR PHONE: � � 2�`' �'(.%j 7 � CONTRACTOR EMAIL• �E %J��,� � ;'�, , � . (�c� <br />CONTRACTOR LICENSE #(REQUIRED): �� F V�� G' C� �� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ���� 7� <br />PRIMARY CONTACT: � OWNER �-CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />u� S�'- �� � Y-c� s 73 <br />`� � A� LI ���C (�i'� CONTACT EMAIL: � �� � � �� C J,,ti�r � �' ,�J <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ,�'l,�t� � Contract Price of Work: $ ��' �' � <br />Proposed Use of Building: ��f'�c; Heat Source: ❑Gas ❑Electric ❑Other <br />Buildin Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />T pe of Pro ect: ❑New f�Addition ❑Remodel ❑Repair ❑T.i. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: • <br />��-6 a� y� Cl��.� �s;,L1� �� ��� � ��,s r�.�:���s�►�� <br />ASSOCIATED BUILDING PERMIT #(if a plicable : <br />ACKNOWLEDGEMENT: 1 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 local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in wrdrng from the <br />Building Oificial before being authorized under any circumstance. ! am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and f comply with the State Contractors Law�18.27 RCW and 296.200A WAC. <br />Agent <br />City of Everett Official Use Only <br />� -��,����� PERMIT#. ( �0/1 � � � <br />lJ <br />Date (Revised �20/2016) �(� <br />b <br />