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� � <br />PERMIT APPLICATION <br />BUILDING ! MECHANICAL / PLUMBING / SIGN / SPRINKLER ! DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E} �u�r�[te�s �t�u�c��ttov�.��rw � wvvuw�.�w�av�fit+�.gr�vi������rtit� <br />PROJECT SITE INFORMATCON <br />PROJECT SITE ADDRESS: � J Z� �Y,�.. _n �� PROPERTY TAX #: <br />( +"�G� <br />LEGAL for new construction: ShoR PlaUsubdivision __ Lot No (attach copy of lo�g legal description) <br />_ <br />CONTACT INFORMATION <br />t�WNER NAME: ��, ��t.'���� `� , �i:>..'tj'-i �C:_t Gi,., �"�-�j;t.`,�'� TENANT NAME {If �Caarn���+�e�i�l}: �. <br />f�WNER MAILING ADDRESS: sTReeT ����" �`G+.U-C�, 1+� v'� _ <br />:;r�� �-V#.''`TE'�C� 5rnre �h%�J�- ��G� <br />OWNER PHONE: ��`'j - �"d{} "i ' �' j��� OWNER EMAlL: �.. : ' �`��� -� - _�'" �!-�p��.:, . � <br />CCJNTRACTOR NAME: z QLV Y��!- �?-- ,�.. �`� �'GL� �.'� �'t+K� cX,' t�4rvlt:tl � L' C+�"" <br />�:r�— — <br />CONTRACTOR ADDRESS: s�aee? <br />�� (Y S7P.T� ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />GCiN7'�ACTtiR LICENSE #{REG1911RED): CITY OF EVERETT BUSINESS IIGENSE #(REQUIRED): <br />PRCN�e��Y CONTACT: pWh�FR ❑ CONTRACTOR ❑ OTHER (Please Specify) „_ <br />CONTACT NAME: CC}NTACT PHdNE: � '' `"w � ���� - j � � � <br />�,. �-� <br />{����--iJ C� ���� GtiNTACT EMAIL: �,e aV f Y.�°�'�� ��} �. }w�C2 � a C.�'°'�`P <br />BUILDING PERMiT APPLICATION <br />f=�ist�ln� lJse or Buildinc: � i��= ��`` °�� �.v�.. t �'� iC�`��C � Contract Price of Work: $ �� ��'�` ��`" <br />l�ri�{axk;�rS Use of Buildin�_ ��" � c;�tl�("�— Si�at So�rce� �� ��Gas -t�cEric ❑Other <br />� �__ � <br />C�uitc}ie�c� Ty�a�. ��FR-0etached ❑SFR-Attached ❑D�,pi�x ❑Multi-F�n�ily# of Ur�its: ❑Commercial ❑Industnal <br />iyf��� nf �'mj�:E�t: ❑New ❑Addition �emr�c�el ❑Rep�ir ❑T.L ��ign ❑�S��r�nkl�r ❑Demolition ❑C;t��r�g� of Use <br />��SC�IPTIC}C*a i�� VilCat�l{: ��{ - ��„, <br />y c' r'�i C; ��� t�� 2�'�t..��P`C`3t'J"l/-�. �„ } v1 C�V ('� 1� �7 �lrir'L�/J1 v�c� �{I'v� �. 1��scF-�S, �ra.Lr��..._.. <br />r.� <br />AS�C}CIAiED BUIIDiNG PERMIT # (if .�se�r�Eicatale�t: Y'ett'`� �-M- <br />FlCKtUOW�EDG%�ME�IT ; hr,we rev;ew�u this applrr.a?ior, and confirm the +nfcrmation cor�ta+neci treroin is trua an�Y r.nrrect W�rk dnne ; ursuani to this pc�rrnit a�tisl cemp!y wittr <br />!:urrer,? foderal, s?ate. ar,d iocral law. 7"hc� �ranGny o1 a p�;nnrt only a��thorizas appr:�vec7 work arid r?a dc��vreNons lhereh�orrr. Devia?ions must f7st be author;zed in �vrlfiny frcrrrt �he <br />I�irilding t�ffrcia! hefore being authorrzed under ar�y cirCumstance. 7 arn J�fe owner, or f am authorized ny the ow�er of7his property fu perform fhe wr,rk ior v.�hicl+ �p�;li::ation is ma�ie. <br />ar�d ! r,;;mply wi(h ;iTe State Cc�,�trar.tors i_aw 18 27 RCW and 296.?OJA WAC <br />,•� y <br />� C;ffy�r�l t�v�ara�t[ ��ftrcz�J d�sr+ �tr91.V <br />,!� ,( % PERMIT # <br />� <br />�.�°`'�'`'`_,,,�'F1J � ,,1 �C:�� .�>~ � 7 �G� � �G' �J - U G `� <br />r <br />� �����. <br />C}wrs�crt�tuthorixnd Agnnt�y�n�tur+��—� Date i'.+�r vas7r,# t./)�92.,��r7f'�# <br />