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10/20/2416 THU 15:a5 FAx a25 252 1666 CM Heating �005/005 <br />• PERNIIT APPLIG�4TION• <br />BUILDING ! MECHANICAL / PLUMBlNG / SIGN I SPRINKLER 1 DEMOLITION <br />CI7Y OF EV�R£TT PERMIT SEtiVICES <br />3200 G�PAR STREET, EVER�TT, WA 98201 <br />(P) 425-257-6610 � FAX 425-257-B867 �(E) everettaps�everettwa,gov � www.everattwa.gov/permlts <br />Bluu 4�r �1.��k In� ��71y PI� sa P��.���T S�T� IN�O'RMA710M� <br />PROJECT 517� ADDRE6S: OPERYY 7AX #: <br />LEGAL for naw oonetrucllon: Short Plat/subdlvlslon__ Lok No, (�ttach Copy of {on� legal desorlptlon) <br />' CO�1'�'I�CT INF��tIVI�(tiOKl <br />OWN�ii NAM�; TENANT NAME If Commer�lAl); <br />OWNER MAILIN� ADDRESS: sTReEr �,� � Q�2„ <br />CITY BiATE ZIP <br />OWNER PHONE: �� OWNER EMAIL: <br />CbNTRACTOR NAM�; <br />CO(�iTRACTOR ADDR�$3; srReET � <br />C� BTATE � ZIP �,� <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: � ���� <br />COPlTRACTOR L10EN$E #(REQLIIRED)�Q� �� ��} GITY OF EVERETT BLJSINESS LICENSE t1(REQUIRED); G � <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Pleaae Speclfy) _�__. <br />CONTACT NAM�; � � CONTACT PFiONE: a�-�"'O � <br />�^� ""� F � I� CONTACT EMAIL: .� �����e �C�� <br />. . . , � . , ..nrw �� ..�Oi. ; .:�i� � , . . . , . <br />Existln Uae oP Bulidin : Contract Prlce oi Work: $ <br />Pro osed Use of BuIIdEn : Heat Source; as C]Eleclrlc ❑Other <br />Buildin 7 e; FR-Deteched �]SFR-Atteched ❑Du lex OMufti-Famlly-€1 of Units: ❑Commercial ❑Induefrlal <br />a of Pro ect; ❑New ❑Additlon �Remodel �7R� afr ❑T.I_ 08i n ❑5 rinkler ❑Demolltlon ❑Chen e of Use <br />DESCRIPTION OF WORK: <br />, <br />�.�- � %� <br />ASSOCIAT�D BUILDINO PERMIT # if a flcable : <br />�". ,� i r ; �Vzti �a , ` , � ,. ', ; <br />Typ� o/ Project: Naw _ Addn �4lteratlon _Rapalr <br />* �� �IBI of F/xtuiea # o/ <br />F/xtures p��u�6 t/sf of �IXtareB <br />AIC — AIr Flandlln Units Neat Pump <br />Forced Alr S scems nit Heater <br />' `'" �;lll� l4 �'�I.IF 4�!��; F�r�4f �' �. �1, , . "�'X$,, ; :. • a , <br />.'�: t;" <br />� umber of Hea s <br />---- �.�� <br />I CKNOWLEDQ�MEIVT.� J hava revlewad rhis epp!lcatlon ane ca�fJrm fhe Inlormsflon oontalned hervin !s trua and ear,acf. Work done purauent lo ihrs parmif musf comply wlth <br />�urrenf fedarel, stafe, and loca/ law, The grenling of a permlt only autharizea epproved work end no devlatlons iherefiom. Devlatlone musl Ifrst be autnorizad In wri�ing �rom fhe <br />3uffding Oflrciel belare belnp authorhed aneer eny clrcumstence. f�m ihe owner, or 1 sm euthori=ed py �he owner a/ thls proper►y fo perlo�m the work tar �vhrch appllcat/on is made, <br />�nd ! comply wl�h fft6 Sfet& Contracto►s Lew 19.27 RGW pnQ 298, 2adA WqC, <br />� . C/fy 0( Ev@rotf 0111C1a1 Usa Onty <br />C`7l // P- MIT#� O� <br />��. ��, � �. <br />)wnar/Authorized Aeant 91gn ture Date (Revlsed 20 20 ) <br />