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425-252-1666 c.m.heating • <br />• 08:19:30 12-22-2015 1/3 <br />PERMIT APP�ICATION <br />BUILDING / MECHANICAL I PLUMBING / S[GN / SPRINKI.ER / DEMOL[TION <br />CITY OF EVERETT PERM{IT SERVICES <br />8200 CEDAR STREEi, EVERETT, WA 96201 <br />(P} 425-257-H61� � FAX 425-257-B657 j(E) everetlepsQeveretlwa,gov � wvwv.evereltwa.gov/permits <br />, . . ,. - --:. _. ,._ _h... _.: .: ., <br />. ,, _ .. :� <br />` _ . PROJECT;SIT�'IN.FORi11�AT10N=; , ..� _; . . <br />DJECT SfTE ADDRESS: 1(� �`�,{ /r_� 1 � n� A,a PROPERTY TAX #: <br />� -r�iaL7t'1rJ11 7'�C� <br />3AL for naw conslructlon: Short Plat/suhdivlsio� Lot No. (attach copy nf lang legal descrlption) <br />,° - ,:_ , �. -_ — — - <br />... - ;:CONTACT INFORMATION_� (:,. ' ' . , <br />OWNER NAME: ��� C <br />OWNER MAILING ADDRESS: <br />OWNER PHONE: �!�' <br />__. _ <br />CONTRACTOR NAME: � <br />CONTRAC70R ADDRESS <br />J Co � <br />r <br />ETREET ��0�' <br />CfTY <br />3 `� �i y �-b <br />.� .. <br />BiREET <br />C1TY <br />CONTRACTOR PHONE: ''j �, � Q. <br />COtJ7RACTOR LICENSE #(REQUIRE <br />PRIMARY CONTACT: � OWNER <br />CONTACT NAME: <br />� ��bbi � � a u� r'S <br />TENANi' NAME (IF Commerclal <br />OWN�R EMAlL: <br />6TATE <br />STATE <br />� . <br />LP <br />7JP <br />� (p (Q(QCp CONTRACTOR EMAIL: �mvt�crnn • �DY:1 <br />:rn N�� s�- da s R 4 CITY OF EVEREiT BUSINE55 WCENSE #(REQLlIRED): �!�Q � <br />CoNTRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: 2 JC 2�q � �� <br />CONTACT EMAIL: e�j�� ��e (�1y�(� , (,p�1 <br />sting Usa of Building: Contract Prlce of Work: $ <br />i osed Use of Bullding: Heat Source: das �Electric �Other <br />IdingType: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Famil -#ofUnits; OCommerclal ❑Industrial <br />�e of Prn ect: New �Additlon C]Remodel e air ❑T.l. ❑SI n ❑5 rinkler ❑Demolition ❑Chan e of Use <br />SGRIPYION OF WORK: <br />�5�, �C�SS �y���T Qu�� <br />OCIATED 6UILDING PERMiT # <br />ACKNOWLEOGEMENT.• / heve revietved thls sppllcallon and con/Irm the lntum�allon contalned hereln Is Irue snd correct. Work dana pwsuant to lhls perrmlt must comply �v!!h <br />current lederal, stalo, and laca! law. The gran!/ng o/ a permif anfy authottces apprvved work and no devieflans (herelrom. DevJellons must frst be au(ho�hed In wrliinp (rom the <br />Bu!lding Offlclo/ 6efare 6eing aulharfzed under any clr�umslance. / am fhe otivner, or 1 am authorized by fhe owner oflhls proparty ta perfom� lhe wak (or which appllcatlon !s made, <br />and I camply wl�h !ha Sfale Confractors La�v 18.27 RCW and 288.2o0A WAC. <br />Clty of Evete(t Officlal Usa Only • <br />I • I� I� PERMIT#��� 1'"/ ( Lr L' r�' <br />wnarlAulhoriznd A t Slgnaturo n D te (Revised 70/12/2015) <br />