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I'E�iVill' ,4Pd'L ICATIOP� <br />�IJILDIiV�MECHARIICA�F'LUMBI�IG I�.pGIV I �PRINKLER / DEfVIOL.ITION <br />CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-88b7 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />aQ.n_��r� c14� INFaRMAT10N <br />PROJECT SITE ADDRESS: %� j� ���n /�G� y� .� C�� I PROPERTY TAX #: <br />!/� �•E <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />__ <br />,. , , _ <br />';CON7AC'i 19�1FORI11i�►TION <br />- .. _ <br />OWNER NAME:L� ��j ��� G�' � y 11- . j'�: �(c>�-C\ TENANT NAME (If Commercial): <br />OWNER MAfLING ADDRESS: sTREer y.��vL 'Cr�.-� '` ;��..�' � 7 L, <br />C I N C_ v(��' 1� STATE �r J` ZIP ���V ✓ <br />OWNER PHONE: 1`�`j ���� � 1`1 `�� OWNER EMAIL: �-'- �� �`7-- � n�-- �� Yyl u� C L�`'y) <br />�1 � , '. <br />CONTRACTOR NAME; Vl/(�' Y 1�C�'Y� <br />CONTRACTOR ADDRESS: s-rReEr <br />CITY <br />STATE <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />GONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE <br />.. , ..., p.. ..a,:... <:, ., .,.� .. .. .... .... . ..... ... ...... ., , �. <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />" BUIL <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑ <br />Type of Project: ❑New ❑Addition ❑Remodel ❑R� <br />DESCRIPTION OF WORK: <br />ZIP <br />RED): <br />Contract Price of Work: $ <br />Heat Source� ❑Gas ❑Electric ❑Other <br />lex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />� ❑T.I. ❑Sign ❑Sprinkler ❑Demofition ❑Change of Use <br />1 i� V t c c�.,f� c�► ��'�'��,1� ��''�� <br />� <br />aGSnCIATED BUILDWG PERMIT # (if applicable): ___ <br />ACKNOWLEDGEMENT.• I have reviewed this application and confrrm the informafion contained herein is true and correct. Work done pursuant fo this permit must comply with <br />current federal, state, and locallaw, The granting of a permii only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing f�om the <br />Building O(ficial before being authorized under any circumstance. l 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 comp/y with the State Confractors Law 18.27 RCW and 296.200A WAC. <br />Criy of Everett Official Use Only <br />�� `�� PERMIT# �r�i ��``-� <br />��. <br />� � ���, � l� <br />_�r ,l` � <br />v r--� <br />Owner/Au orized Agenf Signature Date (Revised i0/1?J2095) <br />