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10/25/2016 TUE 15:03 FAx Q25 252 1666 CM Heating �002/0�2 <br />� � <br />PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKL�R 1 b�MOL.ITION <br />� CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAf� B7REET, EVERETT, WA 98201 <br />(P) 425-257-6010 � FAX A25-257-8857 �(�) evereltepe(�evarettwa.gov � wwvv,ovoratlwa.gov/pormlts <br />(Blue or Black Ink or�l Plea�e) PROJECT SITE IN�ORMATION <br />PROJECT 31TE ADDR�SS: � � PROPERTY TA7( #: <br />LEGAL for new cohelrucflon; Shorl PlaUsubdlv�sion Lot No. (attech copy of Ion� le�al descrlpllon) <br />ER NAIVIE: (�yl,l� <br />ER MAILING ADDRESS: <br />ER PHONE: <br />ONTRACTOR NAME; <br />ONTRACTOR ADORE3$; <br />ONTRACTOR PHONE: t.� <br />ON713AC70k LIC�h1sE #(I� <br />RIMARY CONTACT: ❑ <br />ONTACT NAME: ,. <br />CONTACT INFORIVIAiION <br />��'.i'�� �.�,P1 T�NANT NAM� (If Corrimarclel): <br />sTa��r � �`J � �-i �El � �,(> � � C� �� <br />aTv .-� <br />� �I� <br />-�`_�c <br />BTREET L <br />clsY Q. <br />' 6TATE � � � � <br />OWNER EMAIL: <br />>� <br />- - - BTATE � J � <br />�ON7FtAC70Fi �MAIL: Y�VI Q�Of� � <br />�-r v � ► n ciTY oF <br />NTRAC:70R 0 oTHE e 5peclfy) <br />CONTACTPHONE: <br />CONTACT EMAIL': VI. <br />Exlstln Uae of 6ulldln :- <br />Pro osed Uae of 8ulldin : <br />BU1lding 7 e; �R-Det�ched ❑SFR-Altach <br />Type of Projeci: ❑New ❑Additian ❑Remode <br />DE9CRIPTION OF WORK: <br />� � P��� <br />A330CIATED RUILDING PER # (If a�pllcablo)� <br />QUSIN�39 LICEN9E <br />Bl11LDING PERMIT APPLI�QT�ON <br />Contract Prlce of Wor : $ <br />Hoat Source: ❑Gas r c <br />1 ❑Duplex OMultl-Famll -t� of Unfts' ❑( <br />dRepalr 07.1. ❑Slgn ❑Sprfnkler I�Demollllon <br />L70ther <br />�I <br />ZI�' <br />ZIA <br />❑Industnal <br />of Uae <br />ACKNOWCEUGEMENT. I hovo revfewed th�s appl/cef�on and canitrm fhs informativn c❑nfernod horoin la true and corrocf. Work donQ purscranf lo �hls permll mu�( comply wRn <br />currenf /edaral, s�a�o, And IOoar lew, Tho grenling of e parml� anly 6UfhOflZB3 epproVOd woYk et�d no dovleflons fhBfe(roR7. Dev�pllon8 ITiU31 i!!st b9 aGlhorlZOd Ih W�rllRg lr�m tHo <br />8ul/hAig olricial bulau being eu�horizad under ai7y c/roumsianca, 1 am fha ownev, or 1 am oufhorizod 6y Ihe ownor o( Ihls propo�iy 10 pai/onn fhc wo�k /or wAlch epplical�on ra muUu, <br />ai�dl Comply wlfH fhe Sfofs Conlrectors �eW 18,2) F}CW ond 298,200A WAC, <br />City ot Evoroll 011ic(o! Use Only <br />P� � � � ( � <br />(�0 ' f � � _ <br />OwnerlAuthorizod Agonl 91�naturo U Ravlsvd 9/23i2o96) <br />