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BUILDa�/ M�CI-�ANICAP�P U�NJB P�ICATI� <br />ING / SI�N / SPRINKL�R / DEMOI�1T10N <br />CITY OF EVKRC7T PFRMIT SCRVICES <br />3200 CEDAR STF2ECT, EVFRETT, Wq gg201 <br />(P) a��-257-8870 � FAX 425�257-S8S) I(E) evcrettepg�jcveretiw�,gov � wv+nnr,everettwa,gov/permlts <br />PROJECT 51TE ADDR�h�-. ��.o���cr, ��r� ��rFORn�AT�ow <br />� 0� 0 3�aime �`( �,� Tax u; <br />LEGAL fOr nAw con�tructloh: Short Plaf/subdivi9lon �� ����� "� � <br />I.ot No. (attach copy of Iong IegAl deseriptlon) <br />CONTqC�I' �NFORII�AT�ON <br />�WN�R NAME: � C��j <br />� TENANT NqME (li Col�tmercial); <br />�WNEf� MAILING Ap�R ; S: sTRe�r � o� v- — � – <br />arv V�iY <br />OINNER PhlON�: r'i 2�j ^ y��J ^�i,l � 1 <br />CON'TRACTOR NAM�; �� �� <br />CONTI�AC70R ADDRES$; u7AF� I � � � <br />Cm <br />f� <br />�MAIL: ►'V/A <br />3rnTs <br />CONTRACTOI� pWpN�: �"p 2„�j � l 5-- sTnrF <br />� I � � COMTRACTOR �IVIAI�; <br />CONTRqCT'QR LICENSE #(RCQUIRED): ����x 2� � <br />PRIMARY CONTACT: ❑�W��P � CONTRACTOR ❑ M cirY aF ��ER�� BUgiN�Ss RIC�NSE <br />OTWE(� (Please SpoCify) <br />CONTACT NQME; <br />CONTACT pHONE: � �, �, <br />�.`C'Gl.� � �, �' ' <br />c <br />21P <br />21P <br />ONTACT EMAfL� ��-�; <br />r �5� �r <br />BUyLDINL PE� IT APp��.IC,AT�ON <br />�xistfng Use of Buildin : ' <br />PropGsod Use Of Bufldin ; Ontra�t PriCo of Work: <br />Buildirl T�: v Neat SourC2: []Ga5 ❑EleCtric ❑0����� <br />SFR-Detached C1SFFt-Attached ❑Du lex OMulti-F�mil � of Units; <br />T e o€ Pro'ect; �New CL4ddition ❑Romode� QCommercia� ❑�ndugtrial <br />dESCRIPTION OF WORK� Re alr ❑T.I. ❑S! n ❑5 rinkler ❑pomolition <br />❑Change of Uso <br />�eo�r �� Ch�m�o , r�pl�.c.�. �iv� <br />ASSpC�A7ED SUI�DING T�ERMIT � if a licable : <br />III�ECHAMICq�, pQ�M�� qPP1,�CAT�ON <br />rype of Project: New n,ddn ,aAlters�tlon �Repalr <br />� of <br />FixhirR, �is� of �iziures � of <br />Fixtur'es Lls� Of Fl�ures <br />A/C — qir Nandlin Unitg Heat Pum <br />FOrced Alr Svsfpm� � ��_. . . . <br />Gas Fir <br />Gas Ra <br />ust FaR <br />SP�i1NKLE}� / <br />Waod 5tove <br />SY3T'�M <br />cx�m p . <br />�l.U�1►IBIN� ��R�VI'1'1` �IP�LIC�lt10N . <br />�pe °t p��lo�t: ,New �Addn _Alteration R <br /># of .� opair <br />Flxtures `18t Of l�(NtLreg � af <br />_ .. Fixtul'es List pf �ixtu�ps <br />itchen 5ink & <br />h <br />f <br />roase <br />6 <br />ACKlupW�rDG�IV�ENT' I hev� revleWod thls app�lcatlpn �nd conf/rm thr, �n�rfiatlon contalnCd hem,in ls Irr <br />curyp�f �der,s/, state, Ana iqCA/ law, The gnnting o� � parmu onl <br />Bui/d/ng On/clal bProrn b�ing sutNoriTe:� under �ny clrcumstance I am�ho ow� op or I�m ith Nzed dy �1�C ownCe of �.; f�C i�el/ons � �� {�t D'e au(It � p it muct Comply With <br />end I compry with tna St;oto contractor;o �aW � s. z� R�i,�, ana zse. �ooa wAc. a rn wrn�nA trom rno <br />� P P+�y !o A�'dorm thp Wo� jor wh/CH appllC�tron Is mede, <br />C/ty orCvere(t Otricfal Use Only <br />5 � PERMIT. � � <br />�wneNAut orized Ago gna <br />bgt� (Revised 10/12/7_075} <br />n, <br />