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O1/]'L/2016 7'U� 13:22 FAY 425 379 7045 V1'A Natural Gas <br />�oo2iooz <br />PERMIT APPL[CATION <br />BUILDING f MECHANICAL / PLUMBiNG / SiGN / SPRINKLER ( DEMOLiTION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREii�, WA 38201 <br />(P) 425-257-8810 � FAX 4?_5-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE It�iFORMATION <br />QJ�CyT.-�S,ITE ADDRE�SS: ,, .: �._ PROPERTY iAX #;���4. 7�� /.-, s, r.� �i /�. .--. <br />LEGAL for new conslruction: Short PlaVsubdivision Lot No. (aUach copy oi long legal description) <br />CONTACT II�iFORMATlON <br />OWNER NAME: rj/� � TENANT NAME (if Commerciai): <br />OWNER MAILING ADDRESS: <br />OWNEE2 PHONE: �; <br />CONTRACTOR NAME: ��(j <br />CONTRACTOR ADDRESS: <br />TOR PHONE: ���=, <br />TOR LICENSE #{REQUIR <br />CONTACT: ❑ OW NER <br />NAME: <br />STRGE7 <br />CITY , <br />sraEer <br />arv �7%/ <br />STATE <br />OWNER EMAIL: <br />�t �r-�:�� � .4� <br />� ?�.�� <br />STA7E <br />i <br />GONTRACTOR EMAIL: �_ !��%'jGL7`Lj/Y.� <br />I � C{TY OF EYEF2E77 $USINESS L{CENSE 7E{RE( <br />ONTRACT�R ❑ OTHER (Piease Specify) <br />CONTACT PHONE: �S ��C� �/ � C� <br />CONTACT EMAIL: fi ,�,J • � � <br />B.UILDING PERMIT APPLICAT(ON <br />Existing Use of Building: Contract Price of Work: $ ' UQ • <br />Pro osed Use of Building: Heat Sou�ce: ❑Gas ❑Electric ❑Oiher <br />BuiEding Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Niulti-Famiiy-# of URits: OCommerciai <br />7ype of Project: ❑New C7Addition ORemodel ❑Repair OT_I. ❑Siqn �Sprinkler ❑Demolition L7Chan� <br />DESCR{PTION OF WORK: <br />�` p'� V"l � � �� ����1 LG'� � <br />ASSOCIATED BUILDtNG PERMIT # (if applicable): <br />z�� <br />ZIP <br />❑Industrial <br />of Use <br />ACKNOWLEDGEMENT: l have �eviewed this application and confiim the information conlained herein is t�ue and correcL Work done pursuanf fo this permif must comply with <br />current (ederal, state, and local law. The gran7ing of a permit only authorizes app�oved work and no deviations there%om. Deviations must firsf be aulhwized in writing from fhe <br />Buildrng OHicial before being autho�ized under any c�rcumstance. I am the owner, or l am avthorized by the owner ot this property fo perfonn the work for which application is made, <br />and I comply w' h fhe State Contracfors Law 1827 RCW and 296.200A WAC. <br />Ciry ol Everett Offrcial Use On/y <br />PERMIT # <br />_ / � ( ^ -� � � <br />/ <br />O erlAuthorized Agent Signature Date (Revlsed 10/12/2015) <br />� �,�.�'% <br />