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Sep 07 16 03:58p • p.3 <br />PERMlT APPLICATI� <br />BUILDtNG / MECHANICAL / PLUMBING ! SIGN ! SPRINKLER 1 DEM4LITlON <br />CITY OF �V�RETT PERMIT SERVICES <br />3200 CE�AR STREET, EVERETi, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettura.gov ��.vwi,v,everettwa.gov/permits <br />{Blue or Black Irtk Onfy Please� PROJECT SITE INPORMAT10111 <br />PF20JEC751TE AD�R�SS: .j�� �� ��`L�� � f- �� � PROP�RTY TAX #_ <br />LEGAL for new construction: Short PfaUsubdivision Lot No. (aitach copy of lorrg lega3 descripiion} <br />CONTACT ENFORMATION <br />OWNER fVAME: "��% "f ` --�C.� Y j�� TENANi NAME (If Commercial)• <br />OWNER MAILII�tG AppRESS: srr�EeT ����� G7�U-- �/l �-i— ��J <br />OWNER PHONE; L� � - <br />CQNTRACTOR NAME: %� <br />arr � ',� �-�.-� � <br />�� <br />OWNER EM/�IL.: <br />srnTE <br />ZIP <br />CONTRACTOR ADDRESS: srrxEEr '� � � , ��L,` \J :��� y� <br />cirv '� Cj{,� �� 1 sra� � G� <br />I1P <br />COtVTRACTOR PHONE: -�'� •���-. CONTRACTOR EMAIL: U,r�-{S ��',� L' � <br />CflNTRAC7OR LICENSE �1{REQuiREn�: I l U►� L� SY"�Ch �5 �-{ �.cJ CITY OF EVERETi' BUSINESS LICENSE i�(REQUtF <br />PRIMARY CONTACT: � OWNER I�ONTRAGTOR ❑ pTHER (Please Specifiy) <br />� <br />CONTACT NAME: CONTACT PHONE: � <br />I �-�-�� - � �� - �Q-. <br />�C� SC� - �� �-� �--� V1�Z.�'� CONTACT EMAfL: `� L�YC� � �1Z`�' �i� � � <br />Ezisiing Use of Build <br />Praposed Use af Bui <br />ling Type: ��R-Detached OSFR-Attached ❑ <br />: of Project: �New ❑Addition ORemodel ❑Re <br />CRIPT{ON O� WORK: <br />�;� ��, �,�d <br />ASSOCiATED BUILOING PEI2MIT# <br />� <br />�°, %/I ,L.c-. <br />IG PERM�T APPLICATION <br />Contract Prics of Work: $ , S�� ' <br />Heat Source- ❑ Gas ❑ ectric ❑Oth`er <br />ex ❑MulEi-Family-ii �f Units� -- - �ofiimercial Dlndustrial <br />C7T.1. ❑Sign �Sprinkler �lDemo�itio� ❑Change of Use <br />.�l- ✓✓��-0 (� Y�{5 ��td L�i'F'�'�-�'+:�� �.tl i G{,C,�C �� C.. <br />� . <br />ACiCNOWLEDGEMElYT: 1 hava reviewed this applicalion and co�rm 2he informafion contained he�in �s bue and correct. Work dona pursuarK to this permit must comply with � <br />cu�renl ledaral, state, and loca� faw. The granGng of a permif only authorizes approved work and no deviations thererrom. DaviaG'ons must first be aufhonmd in wnL'ng from the <br />BulJding O�cia! before being authonzed undor any crrcumstance. i am the owner, or I am aufhonzed by (ha owner of this properfy fo perform fhe worfr /or which applicalion rs mao'e, <br />and i comply with !ha Stafe ConUactors Law 18.27 RCW ancY 296.200A WAC. <br />City of Everaft O�cial Use OnJy <br />.1 t" Y� - l �_ I l�/ PE�N�T # � <br />� ����oa ���� ] <br />OwnerlAuthoriud Agent iqnatur' Date (Revised 5/20/2016) <br />