|
�a @'�6Z�IlIT: �4�'PLICA7IOIV
<br />�UILUI� MECH�-iNIC,4L / PL.UfViB1iVG I SIGftI �RINC�tL.�'R / DEN10L.11"ION
<br />CITY OF EV�R�TT PERMIT SERVIi
<br />� 3200 CGDAR STREET, �VERL-TT, WA 98201
<br />(P) 425-257-8810 � FAX 425-257-8H57 �(E) everetteps@everettvaa.gov � www.everettwa.gov/permSfs
<br />. _ .. . , . _ ._ .. ...,: _, :._:::....� ..... ... .:::.::.......:...:::..... ..•-. ,_..:..:. .._::-,-.:.:..:.._.-,,....:.._....:_.:�.:<:.-.:.,.;::s :r. :.. s':::,:r::=;';<::::;,:'::-`s':i;:=:=';.� �'.
<br />� ..; ..t: . �:.�� ': � � i;-.:�?;".i-i:�i=.'_:`:_ :::.::.:::.:::�::r7..:;'.•:..::r:�:;:.i`:7:`;?::
<br />; :::;<=::�::;-,, .:::::;=::,-�::;.- -::�_::.:��:::::_,::::._�: ::�..:;:__:::::-..:::_.:;..:�.:::,: --_ :. , _ . r��.oRm�►Tr .�t_ ._ .. :. ...:: ..: .. ._... ... ...::. . . .
<br />.:, ,_. ,:...,. ..--...._ _..
<br />.._:.__:.,_:_,..,. ,_:._.:_:.:�:.-- _ _ - - - - - --
<br />, .....:.
<br />::.....__. ,::...�::._:
<br />:.:_.=:.=._ _ :: ::: ... .
<br />.-:_. � ._._.:,.,:: .,-.: _,::..,..._. ._. .. _ . _. . ..... .. ..:..� ..: :_..:........... _..... .�.
<br />pfZQJECT S1TE ADDRESS:�$� Z �� " PiZOPERTY 7`AX #; a � � O(i �OC�
<br />LEGAL for new consVuction: Short Plat/subdivision Lot No. (attach copy of long legat descriptian)
<br />.., _ . • ::: •... .,....; , :: = - - _ - _ _ = -
<br />,. . -...:::.�,,:_,:.-....... : ;.-� -
<br />;._ ... :..•� :.::_:..
<br />, .:... , . :.::...:.:.. .. .:...
<br />„ .,.;.:_.:..: �'
<br />-. ,.,-:. :.:.,�,.:.:>_. :.:...�._� ....:::.:.:.. ,...... ::..,: .
<br />, .: •. :; . .,..:..._..;; ��. , ._..,.. ... - -
<br />.. ...- ....:...::.... ..._. :_._. ........... . . ,........ -
<br />_. . : . ..
<br />�.. . . .
<br />. .. ..... .. ..... . .......:.............. ..... . . . .........GOriTA�'frIN�ORMATION';::<':: _:;�`:.�.::;..;_.;:;:.;;. -
<br />-=:••::::::...::.: -::.:.::-..:.: .:: :. >::;..:,�....:. � :.. ..... :...._...: ,..:...•,:...:.....,.. .,.: : . .. , _._ .... _.. . _ .
<br />�,.. �.. TENANT NANiE (Ifi Cammercial): G ,,q
<br />OWNER NAME: � � ( A' C�
<br />OWN�R MAII.ING ADDRESS• sTReEr ZSZ� I%uvr-=.l cS� IO O
<br />CITY /� . STATE j��% Z�' �
<br />PHONE:
<br />CONTRACTOR NAME: � U�-(�S
<br />CONTRACTOF2 ADDRESS: srReer
<br />CIIY ;
<br />CONTRACTOR PNONE: '�f'7„rj' • ,
<br />CONTRACTOR LICENSE #(REQUIRED):
<br />PRlMARY CONTACT: ❑ OWNER 6
<br />CONTACT NANfE:
<br />SA�c(� 8��iL�- i rv C
<br />EMAiL:
<br />�^
<br />wvvt.
<br />STRTE
<br />�- 3 CONTRACTOR EMAIL• r u. f�
<br />� � (� C1TY OF EVERETT BUSINESS L CENSE #(RE(
<br />TRACTOR ❑ OTHER (Please Specify)
<br />CONTACT PHONE: L.� Z,S' -�(� Q� -rJ' (p a
<br />CONTACT EMAIL: _\�t-Ob C� �OI �li � G-
<br />Existing Use ofi Building: Contract Price of Work:
<br />Proposed Use ofi Building: Heat Source: C1Gas
<br />Building Type: ❑SFR-Detached CISFR-At#ached ❑Duplex ❑Multi-Family-# of Units:_
<br />Type of Project: CiNew C1Additian I�fZ�:model I�R�pair e1T.l. C7Sign ClSprir�klsr
<br />DESCRIPTION OF WORK: � � � � O � �, J1 ��
<br />lJ
<br />CIATED BUILDING PERMIT #
<br />❑Eleciric ❑
<br />�'
<br />ZIP
<br />(�
<br />r�� , r �,;+=; �,
<br />Cllndustrial
<br />of Use
<br />ACKIVOWLEDGEMENT.• 1 have reviewed this appfication and confirm the rnformation contained herein is true and correct. Work done pursuant to this permit must canpiy w�rn
<br />current federal, stafe, and loca/ law. The granting of a permif on/y aud�orizes approved work and no deviations therefrom. Deviations must first be authorized in w�iting from lhe
<br />Building Offcial before being authorized under any eircumstance. ! am fhe owner, or! am authorized by the owner of this properfy to perform the work forwhich application is made,
<br />and I comply with the State Contractors Law 7II.27 RCW and 296.2o0A WAC. City of Everett O�cial Use Only
<br />PERMIT# ) i � 1 �, �. ,. 1
<br />u,v+� � � � . � � �� � , , � ( ; ��
<br />Ow er A horized A Signatur Date (Revised 10/12/2095)
<br />
|