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10/28/2416 FRI 7:26 FAx 425 252 1666 CM xeating �002/003 <br />� PERMIT APPLICATIO� <br />BUILDING / MECHANICAL / PLUMBINt'd / SIGN / SPRINKL.ER I D�MOLlTION <br />CITY OF �VERETT PERMIT SERVICES <br />3Z00 CEDAR STREET, EVER�TT, WA 9B201 <br />(P) 425�257-8810 ��AX 425-257-8857 �(E) everefteps�everettwa.gov � �vww.evaretfwa.gov/parmits <br />I�lu'is q�r. ���i�k Ink �Ih Y P��s�� RaqJ�C�r siT� �r�po� Ma'rioN <br />PROJECT 91T� AD�RES6: �� �j • PROf�ERTY TAX t�� <br />LEGAL for naw conetructlon: 5hort Plat/aubdivlslon LoE No, (allach copy of long legai descrlption) <br />� CQ.NTAGT lNFQI�IV1�1T1aN <br />OWNER NAME. TENqNT NAME (If Commerclaq: <br />OWN�R MAILINC3 ADDRES6: sTUE�r <br />CITY STATE ZIP <br />OWNeR PNONE; � I —l� OWNER �MAIL; <br />CONTRACTOR NAM�; ; � • <br />GONTRACTOR ADDR�9S: srraeET � � <br />CITY _ STATE Z,� a� <br />CONTRACTOR PHONE: CONTRACTOR �MAIL; <br />� <br />CONTRACTOR LICEN$E #(REDUIRED): �� � CITY OF EVERETT BUSINESS LSCEN6E #f RE�UIR�D): �4 <br />. . . . . .. . .. . . . . ... . <br />PRlMARY CONTACT: ❑ OWN�R CONTRACTOR ❑ aTHER (Please 5peclfy) � <br />CONTACi NAME� � CONTACT PNONE; � a O� � <br />�� ""r ti�� I� CON7ACT EMAIL: •� {71 / .C� f%1 <br />� , . � - ����� ���(� '�� �fr '4;��;i,�'�T�i��i . <br />Existin Use of Buildin : Confract Prlce of Work: <br />Pro os�d Use of 6ulldln : Heat Source: as ❑Clectrlc ❑Other <br />6ulldin T 9' FR-Detached dSFR Atteched ❑Du lax ❑Multl-Famll -# of Unirs: Commercial ❑Industtial <br />7 e of Pro act: ❑Naw ❑Addltlon �Remodel ❑Ra air OT.f. ❑SI n ❑S rinkler C1Demolltlon QChan e of Use <br />D�SCF�IpT10N OF WORK: <br />���..�.c,�. G� <br />ASSOCIATHD BUILDING PERMIT # ff a Ilcable : <br />"��' ��'1i�►� '� �"�' l�C���,� �, ,, <br />� <br />Typo of ProJaat: NgW Addn ,�AEt6Yetlon �Repalr <br />� ol Ll�f of F/xfurs8 # Of <br />F/xtun4 F�Y�u� Llsl ol F1Xful'98 <br />A/C — Alr Handlln Units Heat Pump <br />ForCed Alr Systeme nit Haafar <br />Water Heater Refrl <br />Gas Flre face Wood <br />Gas Ren e Auctln <br />ClathBs Dr er Hooku e Oiher: <br />Ran e Hoad <br />�nhaus# �an <br />_�>, "ti�?l��4'.l,Il�ll,�il+fi�il�;'51,�4�.���F�S�i�:�.�z�;�:�$T��'; '',"� � I � � <br />� utnber o ea s � � � - <br />ACKNOWtEDQEMENT: I heve revlswad thla app/lcaflon and conf)rm Ihe lnlormefJon confelned hereln /s true and consct, Wor/s done pursuanl lo fhls permH must comp(y wil�_ <br />curreni ledaral, afsie, and locallew, The yrenttng e/p permlf onfy authorizas �ppraved work and no devletlons therelrom. Devleflona musl(Jrst be �utnorl�ed In w��tli�q hrorr� the <br />Eullaing Olticlal betoro balny �ruthorized under s�y c/rcumsfence, 1 am fhe owner, or I am authorized by tlre awner af ihre praperty to pe�farm fhe work for which appllcatlon la meda, <br />a��d / comply w!!h fhA Sfofs Qontractor� Law 9&.27 ACW end 286.20oA WAC. <br />Clty ol Ever�tr ofl/cle! Use on�y <br />PER I #r � Q — ^� <br />\ �-/� I� <br />Revlsed 5/20/2016) <br />