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11/11/2�16 FRI 7:36 FAx �25 252 1666 CM Heating �402/0�2 <br />� PERMIT APPLICATION • <br />BUfLDING / M�CHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITIpN <br />CiTY OF �V�RETT PERWII�' S�RVICCS <br />320� CCDAR 5FREET, EVERETT, WA 98201 <br />(P) 426-267-BB10 � FAX 425-257-6667 �(�) everettepo(�everettwe.gov J www.evereitwa.gov/permits <br />�I� q�' gMa�sk �nk Onl .��e�se PR�;I.�CT B�T� INFQRI�1qTION <br />PROJECT SITE ADDRE33; � 2.� r �,�T'� PROPERTY TAX �'; <br />LEt3Al. for new constru�tlon: ehort Piat/aubdlv�e�on Lot No.� {ottach copy of long le�al daecrlptlon) <br />CON''K'ACT INFab1�IV�'�YIpN <br />OWNER NAME: �.L,��'� �� TENANT NAME (If CommarclaU: <br />DWNER MAILING ADDRE$$; BTREET <br />C Is'I <br />oWN�R PHONE; "1 �7( - ( "� �j <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: eTReer � <br />CIN l A � <br />OWNER EMAIL: <br />srnTe <br />6TATE <br />ZIP <br />zlr <br />CONTRACTOR PWON�: � �� � CONTRACTOR EMA1L; � � <br />CONTRACTOR LICENSE #(R�QUIREDj:� �� Q�t j1 CITY OF EVERETT BUSINESS LlCENB� #(R�QUIREq <br />. . _ . .... . . . . <br />PRlMARY CONTACT: ❑ OWNGR CONTRA�TOF2 ❑ OTFiER (Plaasa $pecify) � <br />CONTACT NAME: � CONTACT PHONE: � "O � <br />�^" ''"a ���`� CONTACT �MAIL: �r•�f � t�`�� `�,��' [J� �C{`i <br />�xlatin Use of Bullding: <br />Pro osed UsB of Buitdln : <br />Bulldfng Type; FR-Dekached ❑SFR-Attache <br />T a of Pro ect: ❑New ddltlan ❑Remodal <br />DESCRIPTION OF WORf(; <br />i p�\���/ � <br />l� <br />A850CIATED BUILDIN(3 PERMIT # (If eppllcable): <br />��- `.;'�, I�,��'�►.,:�. °.���;�1�:�, � �'�a 'M'+ `i�N' . <br />_ ... . .� . .. <br />Type of ProJ�ct: _N�w Addn _f►Il�retlon _Rapalr <br />�a or ��a� of Flxrurea � °� <br />�IXtures Ffxfuroa �let of F/xturv�s <br />AIC —Air Handlin Unlls Heat Pum <br />Forced Alr S stems nil Heaier <br />Gae PI In �oiler <br />Ran <br />.,,y,;�;y � �� . , , <br />:,: �- '� � ,,t�i: �- � ,�:ti•;a. <br />;�.� <br />um er of Heade <br />4CKNOWLEDp,Ep,l�NT.-1 heve revlawed th/s �pp(�cetlon and canflrm fha Informallon contelnetl naraln fe lrue and correcl. Worh done pursua��l to thls permlf mual comply wlrh <br />:unent fedaral, stale, snd local few The eranlf�ip of e permi� vnly authe�lzAs epproved work and no davletlons there(rom. Devl��/ons mus� flrst be eufhor�reuln wrning Jrom Ihe <br />4ulldG�q 011lcle/ before beln9 autftorhed under any clrcumetanco, I em 11�e ouvner, or I am aufhorizad by fhe owner af fhla properly to perfarm the wark ior which appllcaflon /s metle, <br />�nd 1 comply wllh the Stdte Contractora Law 1@, 27 RCW end 296, 200A WAC. <br />Cfty oI Everen O/llcla! Usa on/y <br />�n J 11 lI � PERMI � � <br />' % � <br />�wnar/Autharized Ag�nt BIBn tur� Date Ravlsed 5✓20/2016) <br />Contract Prlce of Work: $__�{�i� <br />Hest Source: �as �Electrlc OC <br />lultl-Femlly-# of Units; �Com►r <br />�❑Sl�n ❑Sprinkler I�Dernolltlon ❑ <br />of <br />5 <br />