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07/08/2016 FRI 10:14 FAx 425 252 1666 CM Hedting �002/002
<br />� P�RMIT APPLICATIOW�
<br />BUILDiNCi ! NI�CHAPIICAL / PLUMBING / SIGN / SPRINKI.Ei21 b�MOLITIO
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<br />CITY OF EVERETT PERMIT SERVICEs
<br />320� C�DAR STREET, �VER�TT, WA 98201
<br />(P) 425-257-8810 J Fl�C q25-267-8867 �(�) everettepe(�everOttWe.gov � www,evereitwa_gov/permlts
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<br />pROJLCT SITE ApDR�$8: l PROP�RTY TAX �;
<br />LEC3AL �or new oonatrucElon; Snort Plat/subdlvlalon Lot No. (attech oopy of long 1ey01 de9orlpt�vn)
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<br />OWNER NAME: ' TENANT NAM� (if Commerclal :
<br />OWNER MAILINO ADbFtEBs: eTRe�T j�
<br />°�TM sTare �� zia ��
<br />OWNER PHONE: L--�o��j �(� ;ZgOLI OWN�R EMAIL;
<br />CONTRACT�R NAME; '
<br />C�NTItACiOR ADDRE88:
<br />CONTRACTOR PHONE: p
<br />CONTRACTOR LIG�N�� #(REQUIR
<br />PRIMARY CONTACT: ❑ OWNER
<br />CONTACT NqM�:
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<br />BTREET
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<br />Ci CONTRACTOR �MAIL;
<br />��(�n cin oF EVeR�TT BUBIN�S6 �ICENs�
<br />TOR ❑ OTHER (Ple$se 8peclfy)
<br />CONTACT PHON�: �� �
<br />CONTACT �MAlL; C!1✓1���/ .,,�
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<br />"���k i.� P�ir, Crti.e��;A:� „p , i�,., ,��,��r��i,\���t; '�' �
<br />Exlstln Use of �ulldln :
<br />Pro osed Uae of Bulldln : '
<br />Bulldln T e: �SFR-Detached �FR•Atteched ❑Du I
<br />T e of Pro ect: ❑New QAddltlon QRamadel ❑Re alr
<br />DESC IPTIQN OF WORK:
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<br />Contrect Prlca of Work; g •
<br />H�et 5ource: ae ❑Electric C70iher
<br />7MuItI�Femlly-# of Units: ❑Commerclal ❑Industrial
<br />�I� dSlgn ❑SQlnklar ❑Demolltion G7Change of Usa
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<br />�IATED BUILDW(3 PHRMfT � {�f eppllaeple)�
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<br />Type of P�oJact: _N�w ,� Addn ,�Ait.rotlon ��apalr Type of proJect; Now „Addn _Altera!!on Fiepafr
<br />� of Llat a�Plxlul'e& ° � af (f o! �
<br />FlxfuYea P7xture4 ��at of i�lxturea p�xturer ��at ofFlxfu»s `fX'u�¢ �f�f o/ F/xfurea
<br />A/C — Alr Handlln Unf e Meat Pump Toflet ackflow Preventer (lnslc
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<br />ACKIvpwLEDOEMENT; f hevo revlawed �h�s �p�llcat(on anci oonllrm the !n/ormafJon oonlalnad har'aln ls lrue and corrsct, Work dorie purauani to fhla perrrllt must comply w!!h
<br />current lederol, afate, end locel law. The �mnj/np ol4 Rarmk pnty au7hoNse� epproved work end no devlatlons thrib/rom, Devlaflona mus� Ilraf 6a authorized hi wrlflnq /rom �1io
<br />9ullding ONICIeI 6eiole be�nq aufhorlsed under nny p1l+Cumsfance. 1 em !he owner, Or 1 Am euthodxed by the owner o/ fyl9 property fo perform ihe work for whlch eppflcec/on fs metle,
<br />end I comply wlth the Sfe(v Contreatora LdW 98,27 RCW and 2DH.200A WAC.
<br />Clfy o� Evereli OIYlc(al Uae On/y
<br />PERMIT #
<br />�Re�rBad a�rlono�o�
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