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0�/26/2016 TUE 12:4G Fax 4252�666 CM Heating �pp3/pp3 <br />PERMlT APP�ICATIO� <br />BUILDMG / MECHANICAL / PLUMBINC ! SIGN / SPRINKLER / DEMOLI710N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-B810 ��AX 425-257-BB57 �(E) everettaps�everettwa,gov � www.e��rettwa,gov/permits <br />PROJECT SITB I FOR�VIATION <br />tOJ�C7 8IT� ADDRE88: �) � �?��/�� ,� � PROPERTY TAX #� <br />L�GAL for new constructlon: Short F�lat/subdlvlslon Lot No. (attach copy of long legal deaorlption) <br />CqNT1lGT, IMFORM4T10N <br />OWNER NAME: � N �Q,� TENANT NAME (If Commerclal): <br />ER MAILIN� ADDRE88: <br />OWN�R PHONE; <br />CONTRACTOR NAME: ( <br />CONTRACTOR ADbIi�SS; <br />BTREET <br />CITY ^� <br />BTREET <br />CITY � <br />BTATE � � 21P Q $ V�O � <br />OWNER �fNAll.� <br />�n � � <br />BTATE �T ZIP � <br />CONTRACTOR PHONE; �� �{ `'l d�0 CONiF�AC701� EMAIL: �d� � ��� � <br />CONTRACTOR LICEN3E #(REQUIREb): � h`fl ��� CITY �F EVERETT 6USIIVESB LICENSE #(REQUIReDj: I� <br />PRIMARY CON7ACT: ❑ OWNER CONTRACi'OR ❑ OTHER (Please Speclfy) <br />CONTACT NAM�; CONTAGT PHONE, �` <br />0 I le���� ✓ �� ��� CONTACTEMAIL:�Q,(,��� �v(�p�h(��(�,� <br />Existing Use oF Bullding' <br />Proposed Use of Bulldin <br />Bullding Type: CISFR- <br />�e of ProJect: ❑New <br />DE8CRlPTION OF WOI <br />�.o� G <br />ASSOCIA �l? �UILDI� <br />BI;IILDING PERMIT APPL'ICATION � <br />Contract Prlce of Work: $ �0 <br />HaatSourca: " Gas ❑Electrlc �Othe� <br />FR-Attachacl ❑Duplex ❑Multi-Family-# of Units; �Commercfal ❑Induatrlal <br />❑Remodel ❑Repalr ❑T.I. _ ❑Slgn ❑Sprinkler ❑DemoUtlon QChanqe of Use � <br />��G�.c�.e�►-I�c� �x� ��� ���5' I i n.e� <br />tMIT # (If eppllcable): <br />rn <br />ACKNOWLEOGEM�NT,� I heve rev/ewed fhls �pplka�lon ond conlrrm tha informat/on contelned hereln !s liue end correct. Work don� pursuenf to rhls perm�f mvst comply wkh <br />cur�nf tedaral, sfale, and foca! Inw. 7he g�anrMg of a permlf only avlhoilzos approved work snd no devialrans therefro�n. Devlatfons musf fl�ef he aiifhoi/zed !n wrl�/ng rrom tne <br />8u/ld/ng O�Icla/ bafora baing �uthorized under any clicurnstance. I orn the owner, or I am autho�lzed by fhe owner ol thls property fo porfo�m the work for which applicaflon !s mado, <br />and � cvmply wlth fhe Stale Con�recrora Law e.27 RCW and 298.200A WAC, <br />C!(y of �verett Ofjlcln! Use Only <br />� � PERMI # O � � <br />�' s o l �, ' �P <br />OwnarlAuthorued Agent Slenatura Dete (R�vJse 9 7? 2095) <br />