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Oct, �. 2U16 12;04PM EVERGREEN STATE HEAT & AC: [N+.spv� (� No.7999 P. 1 <br />A �I \aP�� l�1 l�IG�� IV <br />C3UILDl�/ ��ct�e�t�[c�,t I�LUM�1Nc 1 sI� pRrNK�E�, t D�[�c�I.IiION <br />CITY OF �VEE2ETl� P�RMIT 5Ef2VICE5 <br />'�" 3200 C�DAh S! R�E f, �VER�TT, WA 9�209 <br />(1') A2�-25% 4810 j FAX �2�257-8857 �(�) everelteps�evereCiwa.gov � �Mww.everettwa.�ov/perm[ts <br />B�;o� �3l�a�fYe�i� [�ra9 - �'9�as�) _ �- � PEPrQ��Ci _�l'�� d��O���i4�� . " ° . ° _ � . _ <br />PROJ�CT SIT6 AbDRESS: � PROpERTY 7�d?( #: <br />LEGAL for new �onsttuclion: Short Plat/sUbdiVision �Lot Nv. (altach qopy of Iang legaf descd�tlon) <br />;y. . , - - � � .. , � � . - ��. �a�s�;c�-�1����iin�►�'�o.e� • ° ._ .. , _ - - , <br />O1NN�� NqMk: •-�- �,,;��� TkNAfVr NAfVI� (1P Comrriercial): <br />oWN�� MAtLING ApD�.�S�S: <br />OWN�R PHON�; <br />CONTRACTOft NA�V1�: � � <br />COPITRACTOi2 ADbI��SS: <br />CONif�ACTOR PHON�: �Z�� <br />GpNTRAGTOR 1.iC�Hs� �{(RERUfF <br />PRIMARY CONTAC"f: TC( OWN�R <br />Cp1VTACT NAM�: � <br />s-rn��- <br />Cf1Y <br />� <br />STAEET <br />CITY <br />OWIV�R �IUlA1L: <br />srnT� ��' <br />� // cONTRACTOR �MAIL: � (J <br />��� ']i�' � CITY OF �VERETT BUSINESS L[C�NSE <br />�NTRACTOR L7 dTH�R (please Spacify) <br />, CoNTACT PH4N�: �� ��2���` <br />coN7acr EMAI�; ,�/,��,i� ��� <br />-._�`_ ' � ... - - , . _ ;�.BUII..p�1�G. ��Ft1Vfl�':,A;��'!I:I�CATION <br />E`xfsting Use oF Bullding: Contract Pr9ce of Work: <br />Proposed Use of Building: Heat Soarce: ❑Gas � <br />�BuIlding 7y e- R�Defached �SFR Attached ❑Duplex �1Multf-Famlly� of Un1fs__ <br />rype of Proje�t' CE New ClAdtliflon �1Remodel epalr ❑T.l. ClSfgrt C1Sprinkler <br />D�SCRIF'T[ON OF WORK: <br />C�- � Oc�,r— �� �,�. �.�.{a- c.� <br />�UILbING p�E2fVfIT # <br />�IP "/ � <br />� <br />._ , __ � _._ _._ . - <br />� ���� . <br />C1Electrlc �.O€�r� l <br />� <br />� dCo�imercial ❑lndustrlaf. <br />�]�emolitipn ❑Chancre of Use <br />ACKNOWLEOG�tN�NT.- / have revlev,�ed thls appricerion end canfirm tha in�armelfa� crn(s,ned�erein ]s true and cor�cf. lNork done puisuan( to thls permlt musi comp� wRh <br />currenf tedersl, stata, end Iocalle�v_ Th� qrantfng ofa pormft onfy authohzas appiov�d v✓ork and no davlettons (heref�wn- Deviatr❑ns must first be aulhonzed in v.n�irrg fiUnr tl�� <br />3ullding Olfrcfel befoie belrrg aufho�cecl under sny clrcumstance. / sm fhe owner, or! sm aufhorized by the owner of thls pfoperPy to peilorm !he work for w1�lch app/Icafion !s macle, <br />;�nd /COlnpjywlth the Sfate CanfrAcfo�s,LatN98.27RC1Nend2g8.ZOQAV%AG <br />Clly of Everett Of/Jclsl Use Only <br />P�RNiIT <br />� 20-- - C� C 0 --o� � <br />OwnedAuEhorizad Ar�ent Slgnat�re As(e (ReNsed ��flr`1016) . <br />