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� <br />� <br />� <br />PERMIT APPLICATIOh • <br />BUILDINc� � MECHANICAL / PLUMBING / SIGN / SNRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(Pl 425-257-8810 I FAX 425-257-8857 I(E) everetteps@everettwa.gov ��nnvw.everettwa.gov/permits <br />CONTACT INFORMATION ' <br />OWNER NAME: i � r' TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReer C "'1� 1,/, <br />CITY �"_i /-I� i/'f '.�'i STATE �� ZIP C> �� . <br />OWNER PHONE:� ��_�J .,� �"�o— <br />CONTRACTOR NAME: ����v� <br />CONTRACTOR ADDRESS: srReeT ] <br />cirr � ' <br />JER EMAIL: <br />---, <br />V �: � <br />STATE L <br />ZIP <br />CONTRACTOR PHONE: — CONTRACTOR EMAIL: -j- v �c �c+ <br />CONTRACTOR LICENSE #(REQUIRED)�? ��( j(-�� (�C�'�'�, CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 4 —� �' <br />I �� � �� . � , , CONTACT EMAIL: - � - • ` <br />� <br />BUILDING PERMIT APPLIGATION <br />Existing Use of Building: Contract Price of Work: $� <br />Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br />Building Type� �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of ProjecY ❑New ❑Addition ❑Remodel `�Repair OT.I ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br />DESCRIPTION OF WORK: <br />r��L�,� ������ ��1►��1�� ���. +� —+��� �.c�:�� �� �—f- <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />ACKNOWLEDGEMEN�: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must 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 aufhorized in writing from the <br />euilding Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with ihe State Contractors Law 98.27 RCW and 296.200A WAC. <br />i City of Everett Officia/ Use Only <br />PERMIT # <br />- , � � 1 � � � ,� l (� 0 l - o ��S <br />O ner/Authorized Agent Signature ate (Revised 10/12/2015) <br />�Z <br />