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�9/12/20i6 MOx 9:57 FAx a25 25z 1666 CM Heating �003/4�3 <br />• PERMIT APPLICA�TION• <br />BUI�DING / MECHANICAL / PLUMBING / 516N I SPRINKLER / DEMO�ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE�T, EVERETT, WA 88201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(�) everettepa�aaveretlwa.gov � wv�N.everettwa.govlpermlte <br />��1�� t�Ni�3 aq�:�11��,�tlly,��e�1s8). � ; . ' �'1� �.���'I� $li��`INPbRMATIO.N�' �� , . <br />J6CT SITE ADDttE83; <br />1L !or new aonstructlon: 9hort Plat/subdlvi9lon <br />�- „ , ,' ., <br />ER NAME: <br />ER MAILIN�3 ADdREeS: srRe�T , <br />Ci1v C �i� <br />7�:L�].I�l <br />CONTRACTOR NAME; <br />CONTRACTOR ADDI�E88: sTa��T <br />i <br />CITY <br />� PROPEFtTY TAX #: <br />Lat No. (ettach copy o( long leysi deacrlptlon) <br />' 'CONT��'�`,.��'l�t�.M��l/�C�'I�N <br />T6NANT NAM� (If Commerclal): <br />�, <br />9THTE � <br />�� OWNER EMAIL: <br />. � <br />.SL'� _. BTATE f � ��t <br />C�NTRAC70R PHONEt — ` <br />CONTRACTOR LIC�N9E #(REQUIRED):� <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOFt <br />CON1'ACT NAME: � <br />���`�-�.�-�� <br />' .�1` ., � !��i��i, ';r�'�i� �,�i.� �I <br />Existln Use Of Bulldln ; <br />Pro oaBd Use of Bulldfn : <br />Bulldln T e: ❑SFR-Detached C1SFR-Attached <br />Type oi ProJect� C]IJew ❑Addltlon ❑Remodel <br />ZIP <br />ZIP <br />CONTRACTOR EMAIL: � ' <br />�� �1 CITY OF EVERETT BU31NE39 LICENSE #�REQUIRE <br />C� OTHER (Pleaae Spsalfy) _ _ <br />CON7ACT PHONE: � <br />CdNTACT EMAIL; �Q�(�I`� i�.��f���l�.� ,L <br />Contra�ct Prl�e oi Work: <br />Neat Source: as <br />❑Duplvx ❑MuIII�Famlly-� of Units�, <br />iRepalr C]T.I, p51an . ❑Serinkler <br />� � � ��v�r�� <br />ASSOCIATED B ILDIN(3 pERMI (If epqlicablel: <br />�Elactrlc OOther <br />❑Commerclal Dlndustrlal <br />�Demolition ❑Changa of Use <br />J <br />ACkNOWL�DOEM�NT: ! have r�vlew�d thls epplicat�on end confl�m tHe l�formallon contalned hereln Is frus and oorr�ot. Work dona pursusnt to this perm�f must cemply wllh <br />currant federal, sleto, end tocsi 1aw, The gran(lnp of a pa�mff only �uthorizes approved work entl ne d�v�atlons fherefrom. Devlatlons must 1/rat be authorized In w.�ting from �he <br />6ul/ding Off/cle! before being aufhodied undar a«y clrcumatance. I am �ha owner, or / er» aufha�zed by fhe ownei of thls propeKy to perform the work �ar wnlch appllcallon !s mnUe, <br />and I comply wlth fhe St�ts Contreclors Lew 18.27 RCW ond 286, 200A WAC. <br />Clty of Everett OfllCl�l Use Or�ly <br />! 1� � PER IT t� p ( ��' � �� _ <br />�`� � '� `�� � <br />Owner/Authorizod Apont 31gn ture Date avlsad z z07B <br />