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<br />PERMIT APPLICATION
<br />BUILDING / MECHANICAL / PLUMBING / SiGN / SPRINKL�R I DEMpLI710N
<br />CITY OF EVEReTT PERMIT SERVIC�S
<br />32D0 CEDAR STREET, EVERETT, wq 98201
<br />(P) 425-257-8810 � FAx 425-257-68fi7 �(E) everettepe�everettwa.gov tivww,everettwa, ov/ ermi
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<br />PROJECT SIT� AGDRESs; `' �� pROPERTY TAX #: '
<br />L�pAL for new conettuctlon: 5hort Plat/sUbdlvf�lon Laf N0. (attsch copy of lonp laqal descrlptlon)
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<br />OWNHR NAME: � � TENANT NAME If Ccmmerclal :
<br />OWNER MAILING ADDRESS: erReer � �G( ���C�� ,D�
<br />OWNER PHONE: T�C�C.P
<br />CONTRACTOR NAM�;
<br />CONTRACTOR ADDRE89;
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<br />'TRACTOR PHON�; `"� p(L�
<br />TRACTOR I,ICENSE #(REQUIRE
<br />7ARY CONTACT, ❑ OWNER
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<br />TACT NAM�: •
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<br />n-�r' Use�of 6ullding;
<br />�sed Use af,Bulldlnq:
<br />n T o; ❑SFR-Detached � �
<br />of Pro'ect: ❑New �Addition
<br />iRlPTION OF W01�1(•
<br />AS50CIqTED BUILI
<br />9TATE
<br />OWN�R EMAIL:
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<br />CONiRACTOR �MAIL: -�
<br />� Y� Z�I�I CITY OF EVERETT BU8fN�8S LICENSE
<br />NTRACTOR ❑ oTHER (Piease Specify) _.
<br />CONTACT PHONE; a��� U
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<br />���i'�YL � CPD
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<br />CONTACT EMAIL: ��� ����-� �M
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<br />Prlca of Work:
<br />�Heat Source' s ❑Electrlc ❑Othe�
<br />�Fi-Attached ❑Du I�x C1Mulfl-Famll -# of Units: C]Commerclal ❑Industrial
<br />❑Remodel �Repelr ❑T.L ❑51�n ❑Sorinkler ❑I7wmnllflnn I�rhe,,.,s „F � �.._
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<br />Type af ProJeCt: _Naw _ Addn �qlt�ratlon �Repelr �
<br />� �� Llaf o1 Flxtuns � °f
<br />Flxlure9 Fl,xtur� L/it o1 Plxtuns
<br />ooa stove
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<br />iCKNaWLEDOEMENT: f hewg rev/awed lhia appl/aatlon a�d confirm the /nforme„�„ ,,.,,��a�.,ea nere�n rs rrua qnu ooirecf. Work dane pursuant to th/s per•ml! musf comply wllh
<br />urrent feaeml, srate, and �ocal taw, Tne grantlnp oI a permlt only aufhorizas approved work �r�d no dav;a�lona fherelrom. DeylaUona must llrsf be aufhor/zed !n wi�ring from Ihe
<br />iWld/ng Of/Jolel be(ore 6oing aufhorized under any clrcumstenca. 1 em the owner, o� 1 am aulhorized bY tho owner oi fhia p�operfy to parlorm tHB work for whloh appf/cs0on Is mede,
<br />nd I comply wlth fAe Srefe Confre��ors Lew 18.27 RCW and 288.200A WA�.
<br />C!►y o� Ever�� 011lclal Use Only
<br />P E j�l}� �
<br />d � i<<�3�i� �� � �. �
<br />�•+n rlquthoriz�d qgent 9l9nature � Date
<br />(Revsed 8/23/20�16J
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