5202 S 2ND AVE 2017-01-13 - Laserfiche WebLink

PERMIT APPLICATIO�' (�%U�3 7 (� BUILDIN� ! !!�ECHANICAL / PLUMBING / SIGN . !'!'RINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits CONTACT INFORMATION OWNER NAME: 1 `4 TENANT NAME (If Commercial): OWNER MAILING ADDRESS: s�eeT �j%�L � �� • OWNER PHONE: CONTRACTOR NAME; �: CONTRACTOR ADDRESS CONTRACTOR PHONE: �� CONTRACTOR LICENSE #(REQUIR PRIMARY CONTACT: ❑ OWNER CONTACT NAME: . �� „ �. /-`n � cm STREET CITY OWNER EMAIL: STATE STATE ZIP ZIP � CONTRACTOR EMAIL: �; CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ❑ OTHER (Please Specify) CONTACT PHONE: � �'�� j� (� CONTACT EMAIL: /�, (� � Q"% ,�;/l�,{,/�� C,��„ BUILDING PERMIT APPLICATION Kisting Use of Building: Contract Price of Work: $ � �'� roposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: �,Commercial ❑Industrial ype of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. [�Sign ❑Sprinkler ❑Demolition ❑Change of Use ESCRIPTION OF WORK: � V�S�-t� �� C.� (�� - � � �S � l� / SSOCIATED BUILDING PERMIT # (if applicable): ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant fo this permit must comply w�tn current federal, state, and local law. The granting of a permii only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from fhe Building Official 6efore 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, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # � �.(� `> (,,- <' � �' ) r. Owner/Author Agent Signature Date (Revised 5/20/2016)