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09/28/zp16 wEn iG:a5 Fax a25 25z 1666 CM Heating • �pp2/003 <br />� PERIU�IT APPLICATIOf+� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SI�RINKLER / DEMOLITION <br />CITY OF Ev�RETT PERMI'� SEk�vICES <br />3200 CEDAR STREET, EVERETT, WA 9BQ01 <br />(P) 425-Z67-B610 � FAX 425-257-8857 �(�) OVeretlapaQeverettwa.gov � www.everettwa.gov/permits <br />lu��! +pr �yaQlk In� .Qnl p�e� e PR��1�CT SIT� INFORMATIO�I <br />----- ---._......._..._....--- --------- � � - - ----- — ..._..._..--- <br />pJECT SITE ADDR�SS, � ��� <br />�AL for new construCtlon; ShoR Plat/subdlvtslon <br />OWNER NAME: 1 1 LQ� <br />OWNCR MAILING ADDR�$3; <br />ER PHON�: <br />CONTRACTOR NAME; <br />CONTRAC70R ADDRESS: <br />BTREET <br />CItY <br />� C,� <br />era��T � <br />CIN l A ll <br />CONTRACTOR PhIONE: ` � � C <br />CONTRACTOR LICENSE #(R�QUIPoED):� <br />PRIMARY CON7ACT; ❑ OWNER <br />CONTAGT NAME: �,�� ��� <br />� � <br />Exlstln Use of Bul <br />Pr000sed Uee of B <br />_ �PRpP�RTY TAX #; <br />Lot No. (attech copy oflong lagal deecrlptlon) <br />1 N FU R(1f1,b,1`M � f!1 <br />iENANT NAMF (If Commarclal►: <br />STATE <br />IER EMAI�; <br />..�.� <br />6TATE c,��r� <br />ZIP <br />ZI� <br />CONTRACTOR EMAII,; � ' <br />� �� � CITY OF EVERETT BUBINE3S LICEN8� #(R�pUIR� <br />CONTRACTQR ❑ OTHER (Please Specify) � <br />CONTACT PHONE: � �Qf � <br />CaNTACT EMAII.; ��.�'� Cy��,��� ,C <br />. ,� • ,.. • • '� , �. <br />Contract Prtce <br />Heat Source: i <br />ulldfn T pe: FR-D�tachad ❑5FR-Attached ❑Du lex ❑Multl-Famll -# oi l. <br />� e of Pro ect: ❑New ❑Addlkfon ❑Remodel ❑Re alr ❑TJ. OSI n ❑5p <br />E8CRIPTION OF WORK: <br />��� c�. �- <br />S9�CIATED BUILDING PERMIT # (if aonllcablel: <br />' _ � 1.1�#r s�' �y�.;�: .� �.r,N,�, , ,� <br />: � � ., <br />�8 oi I'�oJect; New Addn �qltaratlon _�apalr <br /># or cr,� orFrxr�res � or <br />F�x�ur�: crar o� ��Xru.�a <br />A/C -- Air Handling Unite Heat Pumn <br />5iove <br />Kange F <br />Exhaust <br />� <br />�ivwnudr or neaqS � <br />4CIGVoW�EDGEMENT.• I huva revlewed fh/s appllceNon Bnd oonllrrn fha lnformat�on contalned hereln Is trus end oorrect. Wark Go�e pursuant fo rhls permr� musi camp�y wiih <br />:urrant Fetleral, state, end locallaw, Th� grenlfng of a permlt only eu�hvrizas spprov�d work and no devletiona theref�om, Dav7atlons mus� iJrst be aufhorlaed M wrltlnp� /rom the <br />Bu11ding dfqcla! be%r� being authorized under any c/icumstance. I um Ihe owner, w f am auihorized by the owner af fhls proper�y ta per/orm fne wark far wh/ch eppllcetlon Is mede, <br />9nd / cemply wlth the State Coniraciors L�w fe.27 RCW snd 29e.2a0A WqC. <br />C/fy of Evarett dfNclel Use Only <br />(� I �I I � PERMIT # — O <br />�wnor/AuEhoriz�d Agent 91gn ture IDate (Revsed 2 2o9B) <br />C7Etectric �Other <br />C7Commarclal �Industrial <br />❑D�molltlon �Changa of Use <br />, <br />� �n 54-� c�c�— <br />