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07/09/z016 FRI ia:u2 FAx a25 252 i666 CM xeating �0�2/�p3
<br />P�RMI"� APPL.ICATIQP�
<br />BUILDING��CHAMICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION
<br />C17Y OF EVERETT P�RMlT SERVICES
<br />3200 GEDAR STREET, EVERETT, WA 90201
<br />(P) 426•257-8810 � FAX 426_257-BB57 (�E) �veretfep9�Bv9retM/21.�OV � wwv✓.everetlwe.gov/permlte
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<br />PROJECT SIT� ADDRES6: � PROPERTY TAX �:
<br />LEC�iAL for new con6tructlon; 5hort PlaVaubdlvl�lon �ot No. (ettach copy of long legal descrlptlon)
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<br />OWNER NAME: R� �� � S TENANT NAME 1f Commeralal►:
<br />OWNER MAILING ADDR�99� STREET �� �'�`"�i�1
<br />Cirv sraTE �'� ZIP O�
<br />OWN�R PHONE: �j�0 ��' OWNER EMAII.,
<br />CON7'RAC70R NAME,
<br />CONTRACTOR ADDR�33; STREET
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<br />ZIP
<br />CONTRACTOR PHONE: � � CON'TFeACTOR �MAIL: �, ,�j(Y'
<br />CON7RACTOR LIG�NSE #{REqUIRED) ~I��r1 CITY OF �VHRE7T BUSINESS LICENSE #(R�QUIFtED): �
<br />PRIMARY CONTACT: � OWNER ONTRACTOR ❑ OTHER (Please Speclfy)
<br />CONTACT NAM� � CONTACY PHONE;
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<br />� �� �� CONTAGT EMAIL: �
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<br />�xlstfn Use of Buildln : Contraat Prlce of Work: $
<br />Pro osed Use of 8ulidln : Heat 5ource: as ❑Electrfc �70fhar
<br />6u►Idln T e: ❑SFR-Detached �FR Atteohed ❑Du lex CjMultl•F�mll •# of Unfte: QComm�rcla) ❑lnduafrlal
<br />a of Pro'act: L.7New ❑Addltloll ClRemodel C1Re �Ir ❑T.I. ❑3f I1 C�8 rinkler ❑Demolltlon ❑Chen e af Use
<br />D SCFiIPTION OF WORK:
<br />���-� �v�� AG� �r C� ►�;f-�
<br />AS50CIATED BUILDIPIO P�FtMIT t! (if aoollr.Ahla1�
<br />"r�''; f•" 1'.��I!1�lf111Y� P4�_I�r.IY�IT"AI".�"4�S�iA'rloN; .; ,._ ,
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<br />Typs o( ProJaot; New _j►ddn AIloretlon _Rap�lr
<br /># ol �,�a� of Flxturea # o� 41at of F7xtuna
<br />Flxh»9s F/rture' �
<br />ower
<br />ter
<br />Drelne
<br />�el Gas
<br />ACKN�WLEDQEMENT: I have rev+ewed thJa eppllFAllon end conl/rm fha lnformetfan confalnod hereln fs five end correct, Wo�k dona pursuant to Ihfa permM muat comply with
<br />currvnt fetlaYdl, 819fa, And loca!lew. The grenting of a permlt only eufhorlYea approved Work and no devlet�ona lherefrom. Devletlons rrtusl 1/ret bs euthorlred In wrlflnAlrvm th�
<br />Bullding Otflcla! bofvre ba/np eulhorrlBd under any olrouma�ance. I gm ihe owner, ar I eM auf7+orlsetl by �he pwner ol fhla property fo pa�form lhe work (pr whrch eppl/cetlon Is mede,
<br />enc� I comply wkh �ha Stata Contrectors Lew 18.27 ACW and 286.200A WAC.
<br />G!ty of Everet! Offlcls/ Use Only
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<br />Qwner/Authorl�ad Aeant SfBnetur� P�te , , ( Avse z0 6
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