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PERMIT APPLICATION <br />BUILDING :CHANICAL / PLUMBING / SIGN I`' �INKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />�' PROPERTY TAX #: <br />ROJECT SITE ADDRESS: � �.�� ��i�'� s�>� ii�;"r r' l� �-a <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />iWNER NAME: `��,�-�C�1 ya)� r l,,�c�Zo'�,� �/2j,� TENANT NAME (If Commercial): <br />IWNER MAILING ADDRESS: sTrzeeT �j ��1� ����z-�L�G�1 <br />CITY L�/ .� ^/`�v4n"V'T ' / STATE 0 ,/�V M l � _ ZIP �'� �C..; <br />ER PHONE: <br />�RACTOR NAME, ���� <br />�RACTOR ADDRESS: srReeT <br />ciTv � <br />ONTRACTOR PHONE: �� G'� B <br />ONTRACTOR LICENSE #(REQUIR <br />RIMARY CONTACT: ❑ OWNER <br />ONTACT NAME: <br />'�1�t..�,r �/�.�,� <br />OWNER EMAIL: <br />STATE <br />� %/v CONTRACTOR EMAIL: �?-f,� �:1'if �G <br />u <br />CITY OF EVERETT BUSINESS LICENSE #( <br />�CTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: �a'j�';tL � <br />CONTACT EMAIL:�/{�fiitJ�C/.� .�Di1/VI�<)3`�/): <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: <br />Proposed Use of Building: Heat Source: ❑Gas <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units:_ <br />Type of Project: �New ❑Addition ❑Remodel ❑Repair ❑T.I. ' n ❑Sprinkler <br />DESCRIPTION OF WORK: � <br />� �� �� w�-� ��y�� <br />IASSOCIATED BUILDING PERMIT # (if applicable): <br />❑Electric ❑Other <br />❑Commercial <br />❑Demolition ❑Chan� <br />ZIP <br />❑Industrial <br />of Use <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit musf comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Offcial before being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT � 0� <br />� Z� � <br />Own r/ uthorized Agent Signature Date (Revised 5/20/20 6) <br />