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09/15/2016 THU 9:05 FAx G25 252 1666 CM Hedting �003/OOG <br />, P�FtMIT APP1,iCATION <br />BVILDING / MECHANICAL / PLUMBING / SIGN / SPRINFCLER / DEMOLITION <br />CITY oF EVERETT PERMIT S�FtVICCS <br />3200 CEdAR STf�EET, EVERETT, WA 88201 <br />(P) 426-267-8810 � FAX 425-267-8867 �(�) eVerettepaQeveroftwa,gav � www.everetlwa,govlpermlts <br />BIWi�'�Q�-B�¢c��Jn�:�Onl �'��aa�d PROJLGT �ITb, j��pO�M,A'�'ION � ' � <br />PROJECT SIT6 ADDRE88: PROPERTY TAX iF: <br />LE(3AL for new oonstrucllon: Shorl Platlsubdlvlalon Lot No.____^_ (pttaCh copy of long lagal ciesarlp4on) <br />� , . � CON7 `�'"�' KNP'4�R�VIAT1,0� , <br />.` <br />OWNER NAME: TeNANT NAME II' Commerclal); <br />OW11lER MAILINd ADDRESS: sTRe�r �j � <br />C�TM STATE ��� ZIP a� <br />OWNER PHON�; • Q`� �, OWNER ENIAIL; <br />CONTRACTOR NAME: 1 <br />CONTRACTOR ADDRE83: sTaeer � <br />c�TM � sTA7E � ziv a�i <br />CONTRACT�R PHONE: CONTRACTOR EMAiL; � .��� <br />CONTRACTOR LICENSE #(REQUIRED};Q� � 9 � n CITY OF �VER�TT BU81N�33 LICEN9E �#{REQUIRED): U�4 <br />.... .. _ <br />_ . <br />PRIMARY CONTACT: ❑ OWNEa CONTRACTOR ❑ OTHER (please 5pecffy) � <br />COIVTACT NAME; � CONTACT PHONE; � � � —Qj <br />��� 1�� CONTACT EMAtL: � ���,�� � j-� <br />� �' � ,'� , .� , �' � �'���� ��',M�I,�. '' ��e 15��• ,�P�Ia��IR4#T14�.F��:, �, � <br />Exletin UBe of Bulldin � Contract Prlce of Work; S <br />F'ro osed Use of Bulldln : Meal S�urce: OGae ❑Electrlc ❑Oingr <br />Buildin 7 a: �SFR-�efeched ❑SFR-Attached ❑pu lox ❑Multl-FBmll -# of Units: ❑Commercial L�Industrlal <br />T e of Pro ect: ❑Naw ❑Addlllon L�Re�modol ❑Re air �T.I. ❑SI n CIS rinkler I7Qemolftlon ❑Chan e of Usa <br />DESCRlPTION OF WORK; <br />1►�;�-�.�.9�. �..�c� ��� � <br />ASSOCIATED BUILDINQ PERMIT # (If appllcable): <br />ACKNOWLEDoEAqENT: ! have revlewed thlg appNvaUon and conffrm Ihe Informallon confe/ned here/n /e bUe and correct. Work done pursuant 10 �hls permr! must comply wl�h <br />cumant fadaral, slafe, end /oce! law. The granUnq ol e permll unly aiithoNzss epp�aved work anQ no devladons there/rom. Devletlans must RYsf be euthorized In wrinng from fhe <br />Aufldlnq Olflclal betare be(ng aulhorized under eny c/r�c�rmala��co. f em the owner, or I am eufhorizad b}� �ha owner of thla propeNy lo perform Iha work lor wRlch aAp!lcatlon !s medo, <br />and 1 comply wlth the Slst� Conl.actor9 Law 18.27 RCW and 296, 200A WAC. <br />Clry o! Everett Offlclal Use Only <br />P�RMIT # � � <br />`� 16 f 4 � -� <br />Ownar/Autharizod Agani Slqn turo Dete (Revlsed W2016) <br />