1909 LOMBARD AVE 2017-01-13 - Laserfiche WebLink

PERMIT APPLICATION BUILDIN�ECHANICAL / PIUMBING / SIGN /�INKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAt2 STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits (Btue or Black Ink Only Pleasej PROJECT SITE INFORMATION PROJECT SITE ADDRESS: '� i( j� L l� ��j �,� �,- PROPERTY TAX #: U� . `� �* �i� � �:,'(� LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: �, 'i�`T I-� l� �� S TENANT NAME (If Commercial): OWNER MAILING ADDRESS: s�ee-r ��j(j� Ll�� '�L � CITY '�` TT STATE �/4� � ZIP �Z��j OWNER PHONE: � Z� "-'3 �,; `� 3'�— OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: s,aEEr CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LiCENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Buifdin : Contract Price of Work: $ Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Famil -# of Units: ❑Commercial ❑Industrial T pe of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Cha e of Use DESCRIPTION OF WORK: ��G\ �i G,'� Y� �' u'i`^,� 11 , 1' `�L Y l C1,'� ��. �t � �� �J ASSOCIATED BUILDING PERMIT # (if applicable): ACKNOWLEDGEMENT: I have revie�d this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal, state, and local law The granUng of a permit only authorizes approved utin�lc and no devia6ons therefrom. Deviations must first be authorized in writing from the Building O�cial before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the uwrk for wfiich applica5on is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A W,4C. City of Everett Otficial Use Only PERMIT# �� i� �� r y. � � � ��'! � �, `� , (Revised 5l20/1016)