Laserfiche WebLink
I'ERiIiiIT APPLIGATIO� <br />�UILDIN�MEChiANICAL. / PLl1M�ING / SIGN I RINKLER I DEf1�OLIT'ION <br />CiTY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />{P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />_. <br />, <br />-: . `- <br />' ` ' ` PROJEC'�' SI"I'E 1_NFA;RMATIOPd <br />::: <br />; ,_ ,, , <br />_ . ..,.: . .__ ... . <br />PROJEC7 SITE ADDRESS: OG 6 LJ l ��d �V PROPERTY TAX #: v OU S'3 1� D Qa �j G O <br />� � -1 7 <br />LEGAL for new construction: Short Plabsubdivision Lot No, (attach copy of long legal description) <br />ER NAME: �G1.Y��I"� <br />ER MAILING ADDRESS: <br />ER PHONE: vI c�-,S^ <br />STREET <br />CITY � <br />'� 1 S <br />aV C�' �Oh11. TENANT NAME <br />�1�q�t tav�a v�e <br />OWNER EMAIL: <br />Commercia <br />STATE w� � ZIP __ q�Q �- l <br />CONTRACTOR NAME' �'rGi�"� W i dC, <br />CONTRACTOR ADDRESS: sTReEr ��j �L f D NE � 7 hT l <br />��n -w�oa�.�.r�< <,� STATE „�-/� Z�P ��o� a <br />CONTRACTOR PHONE: ��� 'Wa — 71 7O CONTRACTOR EMAIL• <br />> T � Zg(�G� c . <br />CONTRACTOR LICENSE #(REQUIRED : CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): � <br />...-. . .:._ . .... .. . . ...:.... . _ �. <br />. ,. ... . . .... . <br />PRIMARY GONTACT: ❑ OWNER L�1 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: vl �j0►�Lda'►Z✓(' b CONTACT PHONE: �a-s'^ �aR'��CO S� <br />CONTACT EMAIL: V La� �(y�. , U►M N. S G c� . C�''� <br />,: <br />, <br />, , . = BU,11 <br />,. <br />Existing Use of Building: �-'GS i. �e <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached �FR-Attached C <br />Type of Project: ❑New ❑Addition ❑Remodel ❑F <br />DESCRIPTION OF WORK: j ty"t D �1/'�/ Wa, � I <br />� </ <br />-�' � v� r i ►� �.t �I� tr . <br />IASSOCIATED BUILDING PERMIT # (if applicable): <br />_ <br />- <br />PERMIT APPLIGATION `. <br />_._... _ _... _ <br />Contract Price of Work: $ � V/ � � <br />Heat Source: ❑Gas ❑Electric ❑Other <br />❑Multi-Family�# of Units: ❑Commercial ❑Industrial <br />❑T I ❑Sign ❑Sprinkler �emofition ❑Change of Use <br />i Vl S vt l�1�4'� ��� �� S�A; rs �tK � Y�a ��? <br />ACKNOWLEDGEMEN7.• I have reviewed this application and confrrm tl�e information confained herein is true and correct Work done pursuanf to this permit must comply with <br />current federal, state, and locallaw. The grantrng of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under y circumstance. I am the owner, or I am authorized by the owner of fhis property to perform fhe work for which application is made, <br />and / comply with the Stafe Contracto w 1(3.27 RCW and 296.200A WAC. <br />Ciiy of Everett Official Use Only <br />�� D �� � PERMIT # <br />o ' -�� <br />Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />