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O8/17/2416 wEn 15:26 FAx �25 252 1666 CM xeating 1�002/D0�
<br />PERMIT APPLICATIO�
<br />BUILDING�ECWANICAL / PLUMSING / SIGN 13PRINKLER / DEMOLITION
<br />CITY OF EVERETT PERMIT S�RVICES
<br />3200 CEDAR STRE�T, EVER�TT, WA BB201
<br />(p) a25-257-DB10 � FAX 425.257-8867 �(E) everettepa(�everettwa,gov � www,�verettwa.9ovJpermlle
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<br />����:i�.�31. .la 'k�',iitKi���l�',�,l�.i�=�'o i � ;: ;�'"�; Pft. �JE�T �$Il� ''I��'ORM%��1'qhf`�;`;' , . ,
<br />PROJECT 91'�E AODRE3S; PROPERTY TAX #:
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<br />LEGAL for new Cpnatruatlon: 9hort PlaVeubdivlslon Lot No. {gttaCh copy of lOhg legel deserlptlOn)
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<br />� ,�,,,���„ ��.,� :�, �.?�c��it',�c��: �-�r ��o�r�nna���oN ; � �
<br />OWNER NAME: Y�NANT' NAME (If Commerclal):
<br />�wNER MAILINO ADDRESS; srRear �' � Q�(� �
<br />CITY - r
<br />9TATE ZIP
<br />OWNER PHONE: ;�a �p� � � OWNER �MAIL:
<br />CON7'RACTOR NAME;
<br />CONTRACTOR ADDRC93� 9TREIc7
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<br />sTarE IAjP"[ ziP
<br />CONTR.4CTOR PHONE: ' ` CONTRACTOR EMAIL: � � ��
<br />CONTRACTOR l.IC�NSE #(R�QUIRED):�{ �� ,� CETY OF EVERETT BU$INESS LICENBl Jf(REQUIR�D):
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<br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTI-IER (Pleaee Speclfy) �
<br />CONTACT NAME: �� ��� CONTACT PHONE; a`—C�, �
<br />� I CONTACT EMAII.; ���1 ���
<br />� � ' � „�. '„�:� , , . ,� BU�� 1'�� �P�RI�j'iT;,laCppR:�� �%�� �I,�N". . .
<br />Exlstln Use of Bulldin ; Cvntract Prlca of Work: $
<br />Pro oaed Use of Bulldln : Heat Source: ❑Oas ❑EleCirlc ❑Oiher
<br />Bulldln T e: C1SFR-Detach�d ❑SFR-AttaChed ❑Du lex ❑Multi-Famll -# of Units: �Comrnerclal ❑Industrlal
<br />T pe af Pro ect: ❑Nsw ❑Addltlon QRemodof ❑Re a;lr ❑T.I. ❑81 n ❑S rinklsr C7Domolitlon OChan e of U6e
<br />DESCRIPTION OF WORK:
<br />���� I�.�� a�� �,� 6� f�.� � C�.
<br />A880CIATED BUILDIN(3 PERMIT � ff a Ilcable ;
<br />� �';VIF��I�.A �+��A���.�� .z' 'PR�L��� �; ! �
<br />4►'�' -: �: �
<br />TYpa of ProJoot: New Addn AJq�taratlon Repolr
<br />� Or LI8t of F/xturge � Or
<br />Plxfuna Plxlures ��sf otFlxturss
<br />A!C — Alr Hendlln Unfte Hea1 Pumo
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<br />9 I IOther;
<br />� �-'° �p�e�t� ����i,'�'.U�� �
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<br />umber o ea s
<br />ACKNoW�EDGEMENT.• I havo revlewed thls eppllcetlon end conflrm !ho lnfonna„o„ conrar�eo nerern �a r�c,a �d congCt. Work don� pursuanf to th�a parmft must comp/y wRh
<br />cwrg�f 1'edarel, sfate, end focel law. Th� granNng of e panrr�t aNy eufhorizes approvad work and no devlAllon� therehom. Davlatrons must flrst be aufhorized In wrn/ng from 1ho
<br />9ullding Oq(c�a/ be%ro being aufhorized urrd�r eny o;rcumstancA. /�m fhe owner, or l em eutHn�lzad by [ha owner of fh/a prope�iy to perlorm the wo�k kr whlch appllcerlan la mede,
<br />and ! comply wQh (he Sfaf� Confractors Lew 1 B.2T RCw and 298,200A WqC,
<br />Gty of EveYeft Olflclsl Use Only
<br />P VI��1 ,� � `� � �' f �
<br />eV/sed fi/70 07B}
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