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PRQJECT SI7E AdDRESS; <br />� <br />� <br />PERMIT APF�LICA7iON <br />Bt111.D11�G ! MECHANICAL / PLUMBING ! SIGN 1 SPRINKL.ER / pEMOLITIC}N <br />CITY OF EVERFT7 PERM17 SERVIGFS <br />3206 CEDAR STRE�T, EVERF7i', WA 8U201 <br />(A) A25-257-8814 � FAX A25-257-8957 �(E) everett�psQeveraUwa gtiv � w�wv.everatlwa gov/permlts <br />PR+OJECT SITE IN�O�itMA'iION <br />� � �.�7� � � � �� PROP�RTY TAX #: <br />I <br />i.ECYAL for new consWcllon: Short PtaUsubdivis�on l.ot No.� (altoch copy nf long fegal descriptlon) <br />CONTACi INFORMAiION <br />OWNER tJAME: ' 1�1��Ji(J ?`}Yl�('�"�l_ TENANT NAME (If Commorclal}: <br />__— , 'Q.n (-,���---- ----- - <br />OWNER MAILING ADDRESS; sraeer `]�� ' I�'t,�.X7N'l ���`-��'^ <br />dWNER PHONE: <br />CUNTRAC70R NAME: <br />CONTRACTOR ADDRESS: <br />C�tTY�'';'� <br />�^�j fi"1 (J� <br />��� <br />sttteer <br />cm � <br />CON7RACTOR PHONE: "��� I.� <br />COFtTRACiaR LlCENSE tl(REQUIRE <br />PREMARY CQNiACT: L7 OWNER <br />CONTAC7 NAME: <br />D�bi e�$ a UC rS <br />•� <br />coNTwacfoR <br />6"fATE <br />QWNER EMAIl�: <br />�+�n YY <br />� CONTRACTOR EtJIAiL: �:U� � GYi��� <br />;' Vq 'rj R� CITY OF EVERET7 6USINP55 UCENSE <br />❑ OTHER (Please Specify} <br />CQNTACT PHONE: ��5 Z�jq (�y�� <br />GONTACT EMAlL: �� ��� � Q� C <br />BUILDtNG P�RMIT APPLIGJ <br />Exlstln Use af Bulfdin� Cantrac# Price <br />Proposed Use of Bulldlnc�: F{eat Source: <br />_._....�. .. <br />Bulidin� TYpo: ❑5FR-Delached �FFi-Aitached ClDuplex ❑Multi-Faml(w-# of <br />T� e af Pro'Lect�CJNew UAdditlo �Remodel �Rapalr OT.E. �Sign ❑: <br />DESCRIP710N OF W�RK: y , �- <br />�nf�-- �� � ��.�Z� G� C..�-- <br />ASSOCIATED BUILQING PERMIT # (if BPPllcable), <br />IIP <br />21P <br />P <br />� <br />[�Elacirlc .I�Other,,,��:,�_r„� <br />�� ❑Commerclal Cllnd� <br />",.:�... ..._...._.�..__.�.._.,, <br />�Qamolitlon �Cttan4e of Use <br />ACKIMOW1.EpGFMENT: ! have revlowed fhis sppifcaGon and cnn�rm thd fqlorma7bn crontatned haroln Is lrue snd carrect. Wark done pursuan� fo Ihls pe�mft musl comply w!!h <br />cur�nt faderal, slata, andlpcal law, The pranfing ol e permlt only authorhos approwd work and no davlatlorrs lherefrom. Devlafior�s must Arst be aulhodzecl !n wrking /iom the <br />Bulldlnp O/Ocln! boloro kning aufl�arfzed wrder any elrcumsfanca. 1 am tho vwner; or ! am nuthorizod by !h� owna� o! firls ruoperrry ta per/orm fho work for whleh sppllcatton Is mad�r, <br />and ! comply wUh !he Staia Conlractors Law 1ti 27 RGW and 246.200A WAC. <br />C!ry ol Evare!( OMc1a1 tJse dnly <br />� � � } � PERMIT I � �/ <br />� � �i � i. <br />wnerlAuthorizod A t Sfgneluro ��le ^� {Ravisvd 11J20i5) <br />��,�' 4.�i.�I ���L��, " �_ <br />n 1 / <br />���� <br />