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08/09/2016 TUE i1:00 FAx �25 252 1666 CM xeating �p02/pp3 <br />PERMIT APPLICATIUN <br />BUILDING�CHANICAL / PLUMBING / SIGN /•RINKLER ! DEMOL(TION <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE7T, wA 9a2o� <br />_ (P) r326-267�8A10 � FAX 425-257-6867 j(E) evereltepe�everetiwa.gov I W1Yw.everetfwa,gov/permite <br />PROJECT SITE ADDRESS: PROP�RTY TAX�t; <br />LEGAL (or new construatlon; 5hort Plet/aubdlvlalon Lok No. (attach oopy of long lepal daecr�ptl0�j <br />, , .�: , , „ . , C4N�AC'T IN Q� AT�ON <br />OWNER NAME: TENANT NAME If Commerclal : <br />OWN�R MAILING AD�RESS; srR�e1 I��c� ��� .i' A� <br />11VNHR PHONE; �'p�� <br />ONiTRACTOR NAME; � <br />_ "� <br />ONTRACTOR ADDRESS; <br />ONTRACTOR PHONE: �–`'�� <br />ONTRACTOR LIC�N8E #(REQl11R <br />RIMARY CON7AC7; ❑ pWNER <br />ONTACT NAME: <br />.� <br />�rReeT <br />o�rr <br />srnre <br />OWNER EMAIL: <br />"' 9TAT� <br />� � CONTi�ACTOR EMAIL: <br />�� j� olrr oF �V�ReTT BUBIN�BS I�IC�NSE <br />ONTRACTOR ❑ OTHER (Pla�se Specify) <br />CONTACT PHONE: <br />CONTACT �MAIL: (/'�/�,�y2�� �y <br />,�,; ;,h, , . , �;. �1 I�1l. .S� :P. N!#,T PR ' 1 i�T. ' ' ' � • . - <br />�xlstln Uae of Bulid(n : Contract Price of Work; $ ( <br />Pro osed Uae of Bulldln : Heat Source; ❑Gas C:lk`lectric , ❑Othar <br />Bulidln e: ❑5FR-Defachad �]SFR-Attachad �bu lex ❑Multl-Famll -# of Units: OCommerclal ❑lndustrial <br />T s of Pro�ect; C,]New DAd�ltlon CaRemodel ❑Ra alr C,1T.1. �781 n I�� rink�er L1Demolltl�n ❑Chen e of Use <br />DESCRIPTION OF W� K; <br />`�;� �f,�.�(� !� �;� <br />�� � <br />AS80CIAiED aUILDIN4 PERMI7 # flf qppflcabfel: <br />ypo of ProJoct� _N0w _ Addn _,/1�t�ratlon Repalr <br /># of L/�t o/Flxturss � � <br />Flxturea Ffxiuraa ���� p��`�Yfured <br />C– Air HandUn Ufl ls Heat Pump <br />Farce Air S etem9 nl eater <br />G�e Plpina n �r <br />Hooku <br />an <br />Type Of Pro�eat; Now Addn �,Altaratlun Rapalr <br />#�� _ L/at af F/xtures _,� °f Lfat ol Flxturab <br />ory (wash da <br />rer � <br />enSn— De� <br />vasher <br />es W�er <br />a�ns <br />Gas <br />n <br />i:•�"11'�� �`', i � �C � �� �i I {i!''���5!' , <br />um er o ea a , <br />ACKNOWL�DaEMFNT• 1 nava revlewaa (his apAlrc�tfon end conf/rm �hr Inlorms(!o� eonfelned heitiln /a trve end aorraot, Work done purauanf to rh;e permrf must comply with <br />Current leder�l, afate, d�d Ioce/ �9w. 7'he pran(Ina ol a perm!! oNy �ufho�iras �pproved Worf. Qnd nn devratlana fhar�irom, devJaflons must Arsf be authorl=sd 1n wrlfing !rom fh� <br />Buflding Ofllcls/ before belny euthwlaed u��d�r pny Clrcum�tev�ce, 1 Am Uta owner, or I em euthorized by the ownar of fh/8 propeMy fo peNorm �he work (or whlch epp/rcetlon Is mede, <br />enC 1 eomp/y wJ1h fhe Sla�o Cantracfera ��W �B, 27 RCW and 288,200A WAC. <br />c;ry ot E�reK omc�er usa o�ry <br />� �I � PFRMIT # <br />� <br />`r . <br />; a <br />Ownor/AuiharlYed Agant Slgnatura Date (Revised �20/2096J <br />