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pERflllllf' APPLICA.T'IOIV
<br />�lJ1L.I�IP MECH�INICAL / P�...UiViBt�l� I �IGN 'i�iNG�CL.�R / DEfI�lOL.17'l�N
<br />CITY OF EV�RETT PF_RMIT SF_RVI(
<br />3200 CEDAR STREET, �VERETT, WA 98201
<br />(P) 425-257-5810 � FAX �}25-257-8857 �(E) everetteps@everettwa.gov j www.everettwa.gov/permits
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<br />PR��I-F���IT�ADD}��� � -�Cr�� �'r�;{C._-� ���I/y�Ytrtlr iHx�;
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<br />LEGAL for new construction: 5hort Plat/subdivision Lot No. (attach copy of long legal description)
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<br />OWNER NAME: � -',�' J' .. � � /�`� � TENANT NAM� (If Commercial):
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<br />OWNER MAIL.ING ADDRESS: sTrtm' i =� (' l�% _
<br />C��, STATE Z�P
<br />OWNER PHONE• �OWtJER EMAIL:
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<br />CONTRACTOR NAME� �j!� �/ S � ��/� / ,_— ls' ��� �`� ��� �'
<br />CONTRAC70RADDRESS• srr�EEr SfL`' ��' �(` / � L %-i � �✓ �
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<br />CONTRACTOR PHONE: � � ( - � .� � � ? (` S CONTRACTOR EMAIL: , �� .t � t ,/�
<br />CONTRt4CTOR LICENSE #(REQUIRED): �' S��) �� ��C U� � CITY OF EVERETT BUSINESS LICENSE
<br />PRIMARY CONTACT: ,�d'OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify}
<br />CONTACT NAME: CONTACT PHONE: 2(y� - , J�Z `
<br />CONTACT EMA1L: ��
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<br />Existing Use ofi Building: Contract Price of Work: $ `�i ��`� �'
<br />Proposed Use ofi 8uilding: Heat Source: ❑Gas �Electric ❑C
<br />Buiiding Type: ❑SFR-Detached C1SFR-AttaGhed ❑Duplex ❑Multi-Family-# of Units: ,IZ�Comrr
<br />Type of Projecf� ,�New ClAddition ClR�model �1R�pair L7T.L CiSign �5prinkler Clpemolitiart C1
<br />DESCRIP�TION OF WORK: � �< /�J� �" �f � fij� �'j% ,f,.�.1, �- r� � ��� ��t� � �
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<br />ASSOCIATED BUILDING PERMIT # (if applicable):
<br />Cllndustrial
<br />of Use
<br />ACKNOWLEDGEMENT.• 1 have revi.ewed this application and confirm the information contained herein is true and cor�ecf. Work done pursuant to this pennit must compiy w�rn
<br />current federal, sfate, and foca! law The granfing of a permif only authorizes approved Work and no deviafions therefrom. Deviations musf firsi be authorized in writing from fhe
<br />Building O�cia! before being authorized under any eircumstance. ! am fhe owner, or J am auihorized by the owner of fhis property to perform fhe m�ork for which application is made,
<br />and 1 comply wifh the Stafe Cont�acfors Law 98.27 RCW atid 296.2o0A WAC. City of Fverett O�cial Use Only
<br />, � � PERMIT�}, � �,�, -�
<br />� ���h_ � �-1 f� ` �j �/, .,, I ,
<br />O er/Authorized Agent Si na ure Date (Revised i0/92/2D95)
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