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• ! <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL I PLUMBING / SIGN / SPRINKLER I 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 � vv�wr everettwa govfpermits <br />NER NAME: �R� � /�� T� <br />NER MAILING ADDRESS: srReET <br />GIIY <br />PHaNE: c3(o0 - /� �t�l - <br />CiM1ITRACT�R NAME: (�'}y�yt�,Y�'f't <br />OtJTfiACT�R ADDRESS: � srk� r: � <br />CITY <br />C?NTRACTOR PHONE: '�( o�`��tS�c <br />4�NTRACTt�R LICENSE #(REQUIREO): <br />RIMARY CONTACT: ❑ OWNER L� <br />ONTACT NAME: <br />CR.4/ 6 �lS��'. <br />CONTACT INFORMATION <br />� �/�/ TENANT NAME (If C <br />1'Y!a � �'�.f�ue.�� f�:✓..�.a�, . <br />�. l/�- <br />ER EMAIL: �.h��('. <br />;rnrr (ti%/4 <br />� _�' l�e. <br />_ �. <br />1 �b Z-'`/ /S''�"'` .�t'iru.�e cS'E �#/a/i4 <br />�` <br />.4,}. .`iTATF.. k(,/�''r- <br />- 0/I l CONTRACTOR EMAIL: �l.►-Q ��6¢g; <br />;�� N���O Z 2C�% CITY OF EVERETT BUSINESS LICENSE <br />�ihiTRACT(�R ❑ OTHER (Please Specify) _ <br />� � . <br />• y <br />/ � : • , <br />�rs�� <br />.r� . �i-yt.. <br />REO): D (��' <br />CONTACT PHONE: ��,_���-_0��/• ,�� _ 7�� _ �-�y� <br />CONTACT EMAIL: ��,.,,�,, � d � f`A„3,.+�2t�t�Cfi9�ara,�i:/`,`�q, GB..m, <br />BUILDING PERMIT APPLICATION <br />istin Use of Buildin : Contract Price of Work: $ �i ��• DO <br />>pnsed Use of Buildin �� Heat Source: ❑Gas ❑Electric ❑Other <br />ildiny Type ❑SFR-Detached �FR-Atiached ❑C�wplex ❑Multi-Family-# of Units ❑Commercial ❑Industrial <br />ae of Proj�ct ❑New ❑Addition ❑Remodel C�tepair ❑T.i. ❑Sign ❑Sp�inkler ❑Demolition ❑Ch�nge of Use � <br />SCRIPTION OF WORK: <br />I�mo�e <.s-r►�O�: t,� 9�- r.zP(a.c�. t,�i�. Ge�'�o&���8�-i. <br />SqCIATED BUILDING PERMIT # (if appiicab�ej. <br />ACKNOWLEDGEMEN7 / have revievded thrs application and confirm the informafion cuntained herein is true and correct. Work done pursuant to fhis permit must comply with <br />cunent federal. state, and loca/1aw The granting of a permit onty authorizes approved work and no deviations lherefrom Deviations musf lirsl be authorized rn wrifing trom the <br />Bwtding Offrc�al 6efore berng authorized under any circumstance / am lhe owner, or I am aulhorized by fhe owner of th�s property to perform �he work for which applrcalion is made, <br />and I comply wdh the State Contractors Law t8.27 RCW and 296 200A WAC <br />City of Eve�ett ONicial Use Only <br />PERMI, <br />,�.-L�. �'�> .ZD/(Q I . I <br />OwnerlAuthorized Agent 5ignature Date (Revised i0/t�r7.0f5) <br />