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11/1Q/2016 MON 9:19 FAx Q25 252 1666 CM Hedting
<br />�002/002
<br />PERMIT APPUCATION
<br />BUILDING / MECHANIGAL / PLUMBING / SIGN I SPRINKLER / DEMOLITION
<br />CITY OF EVER�TT PERMIT SERVICES
<br />3200 CEDAR STREET, �VERETT, WA 08201
<br />(P) 426-267-9810 � rAX 425-257-eB57 �(E) everetteps aQeverettwa,gov � w�ntiv,everetlwa.�ov/permlts
<br />lu'� ,Pw:`�. ���c.'�r14c`:�ntai,��e�,'se " � ' i'PRaJ C"�' S1T,�',`II�P'�laMAY1bN
<br />PRQJ�G7 SIY� ADDRE58: � I� V � PROPERTY TAX #:
<br />L�C3AL for new constrUCllvn: 9hort PlaVaubdlvlslon Lot No. (attaah copy of long [egai desorlptlon)
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<br />OWNER NAME: y _ �,C%'j TENANT NAME If CommerGial)�
<br />OWN�R MAILINO AbDREss: srRe�r �-,�2i I S1� �Y� \n/
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<br />OWNER PHONE; �'"�O'��
<br />C�NTRACTOR NAME; /'�{/�/�j_�
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<br />CONTRACTOR ADDRESS: srRe�r
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<br />� IOWNER �MAIL;
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<br />'�� .�r: .
<br />srare
<br />87ATE
<br />CONTRAC70R PHONE: � ' CONTRqCTOR EMAIL: � �
<br />CONTRACTOR I,ICEN3E #(REqUfR�D)� � q 1 � CITY Of �V�RL7T �U91NE9S LICEN3E
<br />PRIMARY CONTACT; ❑ OWNER GOiVTRACTOR ❑ OTHER (Pleas� Speclfy) �
<br />CONTACT NANl�; � CONTACT PHONEt �' a C?� (7
<br />����I� CQNTACT EMAIL. iV�DG nl�...l-B� �/,�nInOQ+f
<br />i . ..'T.., ��?�; ... ,.. . � . n',,.:l���i'� _ � ,a�� , , ,i.
<br />;Istiny Use of Bullding: w
<br />0 osed Uee of B Ildln ;
<br />�Ilding Type: FR-Detached pSFR-Attached
<br />pa of Projec�� �New QAddltlon C1R�model
<br />:sCRIpTION OF WORK:
<br />[ � I�� r� C�
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<br />iSOCIATED BUILDINC3 PERMIT # (If applicabl0):
<br />►���.`��'�?��,'��A?�X1�.��;. �
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<br />ContreCt Prlce of Work� � ���
<br />❑Duplex ❑Multi-Faml
<br />❑aepalr ❑T.I, ❑Slan
<br />+�� � ,��r*.�.•� r,w,�X „l�N,�ur� . I!_*�Al.�I.'q.'cwa..,i�RIM�K�",�., ..�,V�'� '
<br />Type oi ProJoct: ,_,N�w Addn Altaratton _Repelr
<br />� or �lar o►�rxtu�8 `� or
<br />Flxfult�d Flxtures ��at of Flxturss
<br />AJG — Alr hfandling Unlfs Heat Pump
<br />� rorcea A�r 5 stems
<br />Qas PI In
<br />ater Heater
<br />Qas �Ire lace
<br />as Ran a
<br />Clothes D er Hoak�
<br />Ran e Hood
<br />Exhaust Fan
<br />�,.�� :Y.:�;.� . . . �Y k/��. u,�� 1�
<br />r:
<br />_ � �rvumuerorheads �
<br />ACKNO WL�DOEMENT.• I have revlewed fhla appllcaUai end conl/r�n tha lnformeflon confalnad herein ie Irue and correot, Work done pureue»t to rhls permlr musf comply w/rh
<br />currenf federef, etets, entllocal /ew, Tha pranting af e permlt on►y aulhorlres approvad wak and no devlatfona fAsrefrom. Dav/aUons mus! Nrat be au�horFred In wrlting from tne
<br />BulldlnD O�flclal batore being a[rthoNzed under any clrcums(snce, I em the owner, or! ain eufhorlted by !he owner o/ fh/s propeKy to perform fhe work lor whkh appl�cetlon !s n�ade,
<br />and ! comply wlfh the 5lete Conlractors Law 1 B.2y 17CW and 296, 200A WAC.
<br />cily of Evereft Offlclal Use Onry
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<br />P�f`�#�<<--O
<br />Dwner/Authorl:ad Apent 91gn ture ate (Rev(sed H/20/1016)
<br />zIP �4� f�
<br />21P
<br />m
<br />❑Electr�c CaOther
<br />❑Commarcl0l Dlndustrfal
<br />❑Demolltion ❑ChanQe of Use
<br />
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