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09/O1/2016 Txu ia:53 FAx a25 252 i666 CM xeating <br />f�003/OOa <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING I SIGN / SPRINKLER / DEMOLITION <br />CITY pF �vERETT PERMIT SEI�VIG�S <br />3200 CEDAR STREE7, �VERETT, WA 98201 <br />(P) a2a�26�,8810 � FAX 426-267-8857 �(�) everettepa(�evereltwa.gav � wuw✓.ev�r�t[wa,pov/permlts <br />8 u'�;'i�r. I��k.�Irf1��l�nly Pla��s • �'pF,� ��CT'$IT •.IN���F��1IIi�►TI�CIN� <br />PROJECT SITE ADDRESS: � � �i PROP�R'TY TAX #� <br />LEGAL for hew cvnatructlon: Short PlaUaubdlvlalon Lol No. (�ttHCh Copy of Ivng le�al deecrlptlon) <br />„�. , .. ��.�r.�_.�— ----��.�.,.---�- , . <br />DWNER NAME: <br />�WNER MAILING ADDRESS: itEEr �� I <br />PFiONE: <br />C�NTRACTOR NAME: <br />CONTRACTOR AODRESS <br />cirr <br />BTR��r <br />t <br />arr <br />CONTRACTOR PHONE: C{- ��� �� L <br />CO TRACTOR LICENSE �(REqUIRED);C <br />PRtMARY CONTACT: L7 OWNER <br />CONTACT NAME: � <br />�r�`��.1`�'�� <br />`''1 <br />7eNANT NAME (lf C <br />OWNER EMAII..; <br />STATE <br />lif �/ STA7E ���� <br />i CON712ACTOR EMAIL: � <br />�� �� C1TY OF EVERETT �U61N�SS UG�NSE �!( <br />C�NTRACTOR ❑ OTHER (Please 8peclfy) � <br />CONTACT PHON�: � � �—� (� • <br />CONTACT FMAIL: �Qdl�l 1 C�''� P <br />";` " ' � . �'��uM�L1���Nt'�` ,�.� :a :�'IQ �Y;' , (�', <br />�xlstln Use of Bulldln : Contrect Prlca of Work: <br />Pro osed Use of Bulldin ; Heat Source: ❑Gas <br />Bullding Type: ❑5FR-Detached ❑SFR-Atteched ❑Dupfex ❑Multl-Family-# �f Units' <br />Type of ProJect: ❑New ❑Addltlon ' ❑Remodel C]Repalr ❑T.I. ❑Slgn ❑Sprinkl�r <br />DE3CRIPTION OF WORK; " ' <br />��5�-� �� �,� � <br />� ��� <br />A890CIATEb BUILDING PERMIT # (if applicab ): <br />Z�P <br />aiP <br />OUIRED): <br />, <br />C�lectric ❑Other <br />❑Commerclal ❑Industrial <br />[�Demolitlon ❑Chan�e of Uae <br />ACKNOWZEDGEMENT, / have revlewed rhis appllcat7on end Conllrm !he /nlormatlon contalnad Nereln is fruB and correcl, Work dono purauanf to lhfs perrnit muar comply wlth <br />current fadaral, slsla, and /ocallaw, The g�enfing ol a permlt only eulhoilzea approved work and no devlet/ons iherefrom. Davlaflorta musl I1�•st be autharized in wrlling /rom Ihe <br />8ullding O/l(clal belore 6eliig eufhor/zed under any clrcumstenea. I em Iha ownar, or 1 am aulliorlsed by fhe owner af thls propedy fo perlorm lhe work (or whlch epp!(cst�on Is made, <br />snd I comply �vlrh the S�afa Conlraclore �aw 9b_2� I4CW and ?9�.ZOOA WAC. , <br />Clry o/�varett ollicial Use Only <br />' PE IYIrT�� <br />- � 0�� ���,� ����-- �,r�� <br />Ownar/Authorlaad Agant Slgn turQ Data {Revised 6/20/2018) <br />