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PERIl�Ii AF'PLIG,4TIOP' <br />�IJILDINS�I IVIECHAIVICAI. / PLUMBIP�IG / �IGt�I � �rRIR1KLER / DENIOLI�I'ION <br />CITY QF EVERETT PERMIT SERVICES <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 />,.. <br />; ,_ -; . aR:n.IFr� SITE IMF(JRMATIOPI. . . ; , <br />� � �.,.,...., . .., .�<<,Z� _ �..�_ �,{.� L- (_-�--�,, <br />LEGAL for new construction: Short at/subdivi <br />OWNER NAME: �� �. �c:, V�, �, L,_-{-� �� i t 1-�-� t <br />OWNER MAILING ADDRESS: rREeT � G yjU �`v <br />CITY � J{'G( <br />/ l �, <br />'NER PHONE: �.1OF,-�� �� �" l "-Y' �� �'I <br />NTRACTORNAME: L-` ��J-��1 <br />NTRACTOR ADDRESS: sTRE�r <br />CITY <br />L L <br />PROPERTY TAX #: <br />No. (attach copy of long legal description) <br />TENANT NAME (If Comm <br />G� C�, (� �� 1� <br />STATE ��� <br />OWNER EMAIL: G l��' �- �� C.v'✓v� C cl � <br />STATE <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CIN OF EVERETT BUSINESS LICENSE <br />_ ... ...- . : .. ,:.. .......,.� .... .... . ... .. ... .. . . . ..... <br />PRIMARY CONTACT: Ij�OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />ZIP G' � � C,� <br />�-� - � <br />ZIP <br />RE�): <br />CONTACT NAME: CONTACT PHONE: Zv �� ��C '-� -' �%`� �''� � <br />C'��' ��'�'" ��C��- CONTACT EMAIL: C. -�' r <br />. �� '�; C; c� w� C� c� f. � L� -r <br />,. ,: <br />.. . .. <br />_ - :B.UlLD1NG::PERNIIT APPLICATION `.. <br />_ ,. <br />_.. _ _ <br />,: _ <br />xisting Use of Building: C� �,n vrt.� 1 C_ Z� ��� -C < 6iz �� �<�_ Contract Price of Work: $ �-% '� `� �� <br />roposed Use of Building: `� C✓ww- Heat Source: as �Electric ❑Other ��+ ���-�-- <br />uilding Type� ❑5FR Detached ❑SFR-Attached ❑Duplex �Multi-Family-# of Units: >> Z 331Commercial ❑Industrial <br />ype of Project: ❑New ❑Addition ❑Remodel �Repair ��.T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />ESCRIATION OF WORK: �7 , �% ( �1 � <br />�'�-C �C.i.,�--V- � IV-r ' l L'✓1 Gl ,'�� "Y ,71 � � G � Z 'h-�`> IG�' C �/1 � ��l �-' ' G �—, <br />� � I � � � 1� 1:-v � vv�� � ` ��-� �j�'' `� `� i ���-�-�' . <br />' 7 -�, � i, �„v� C� �' y� Gl <br />��'C c',.� ,,,: L�-�� "�_ ��:ti��tl-.�2� ti� � Lk� Z <br />ccnrierFn Rull nING PERMIT #(if applicable): � ) _ � <br />ACKNOWLEDGEMENT.• 1 have reviewed this application and confrrm the information contained herein is true and correct Work done pursuant to this permit must comply wfth <br />current federal, state, and loca! law. The granting of a pennit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. ! am the owner, or I am authorired by the owner of fhis property to perform fhe work for which application is made, <br />and I comply with the State Contractors Law .�RCW and 296.200A WlIC. <br />j City of Everett Official Use Only <br />�, <br />� � PGRMIT # <br />� GC -C ��-! � �� � l c; ( �. �j � % 0 �i �- (i �� <br />Owner/Authorized Agent Sig ature Dat (Revised 10/12/2015) <br />