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425-252-1666 c.m.heating � <br />� 12:56:17 12-11-2015 2/2 <br />PERMIT APPLICATION <br />BUILDtNG / MECHANICAI. / P1.UMBiNG / SIGN / SPRINKLER / DEMOLIT[ON <br />CITY OF EVERET3' PERMI7 SERVlCES <br />3200 CEPAR STREET, EVERETT, WA 8820'1 <br />(P) 425-257-8810 ( FAX 425-257-H857 �(E) everettepsQoverettwa.gov � wµnv.everetlwa.gov/perrnits <br />- - ._ __ :..__ - ' <br />_ ..,. `� _`,, _._ ;� � ;: _ ';; _;. = ; . .PRaJECT,SITE;'INfORMATIO.N : <, , ; . _ . - <br />PROJECT SlTE ADORESS: 1� 17 �v��O,..e PROPERTY TAX #: <br />LEGAL for new consWcllon: Short Ptat/subdvlsion Lot No. (allach copy of lonp logal deccripllon) <br />_. , <br />, . _ _ _ ._ ,.. . ., <br />_ - ., � <br />.. .. :';. ,: _ � ICONTACT, INFORMATION-;: • : `+ . ., _: _ <br />OWNER NAME: �i 1� S�eU LD ��I7Q�"ti,+ TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sraeer ���� VV�'i}'101rQ �, <br />CRY 6TATE �1�/� ZIP -1 g f(.J I <br />OWNER PHaNE: � ZJ 252 �y3 OWNER EMAIL: <br />CONTRACTOR NAME: C <br />CON7i2ACi'OR ADDRESS: <br />srR�r <br />cmr <br />CONTRACTOR PHONE: ''� L � Q.,� <br />COfJTRACTOR UCEtJSE #(REDUIRE <br />PRIMAfiY CON7ACT: ❑ OWNER <br />CONTAC7' NAME: <br />i7 �bi � � a u� r5 <br />L. � SiATE yV ZJP <br />� �tvroCv ���t�,�TORE�A,�: GmY�eA�finc <br />• � L.� y��`7 7 R�1 CI7Y OF EVERETT 6USINESS LICENSE �l(REf1U1F <br />CONTRACTOR ❑ OTHER (Pisase 5pectfy) <br />COtVTACT P1iONE: 25 2�� � � � <br />CONTACT EMAIi.: e �DlUle (`.�:� � e(X�jy�Q <br />Existing Use of Buliding: <br />Propased Use of Bullding: <br />Building Type: ❑SFR-Detached "�,SFR-Attached <br />Type of ProjecL ❑New C1AddiUon ?�IRemodel <br />DE5CRIPTION OF WORK: <br />��Sfia�l G�15 iNse�r <br />ASSOCIATEb BUILDING PERMIT # (iF appllcable): <br />Contract Prlce of Work: <br />Heat Souroe: �Ges <br />❑Duplex �Muili-Family-# of Unfts:_ <br />Reaair ❑Y.l. ❑Sipn ClSorinklar <br />. �D i:� <br />� 3y oCo. CQ � <br />❑Efectrlc ❑Olher <br />❑Commerclal ❑Indi <br />L7demolition ❑Chanae of Use <br />ACKNOWLED(3EMENT• 1 huve rovlowed th/s eppl/ca(!on and canOrm fhe fnfonna!!on contalned heraln is (rue end correcL Wo�k done pursuenf fo ihls pormlt must comply wfth <br />currsn! federal, sta(e, und /ocallaw. Ths gran!!ng of a permlt only au(harfzes approved work and no devlaflons iherefrom. UavlatJons must Orst 6e au(horlrod In wri(!ng fmm Ihn <br />E3utld(ng Offlclal bofore keing aulhorized under any clrcumslanca. ! am the owner, or! am aufhorhed 6y tho owrter of (hIs property to perfomt tho work forwhlch appllcatlon !s mado, <br />and / comply wllh tho Slale Confrac(ors Law 1B.27RCWand 29e,2o0,4 WAC. <br />Cify of Everelt Ofliclal Usa Only • <br />+ PERM T# <br />� ' ,� I� I� �� n,. <br />V <br />wnadAulhoriznd A t Sic�naturo n �ate (Revlsed 1Q/i2�2015) <br />� _ _ _ __ ����'� <br />