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11/08/2016 TUE 7: 22 FAx Q25 252 1666 CM xedting � �' _� �� f-�002�-- <br />� � U �� U b-- <br />PERIVIIT APPLICATION ��� <br />BfJILDING / MECWANICAL / PLUM8ING / SIGN / SPRiNKLER l DEMOLITION <br />CITY O� �VERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERCtT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps�eversttwa,gov � w�wv,everetlwa,gov/permlts <br />�IuQ <1C �l�p�.lnk wtl pleSse PRQJ�CT SIT� INF01`2M4Ty0N <br />PROJECT 61TE ADDR�SS: � <br />LEGAL /or new constructlon� 5hort Plat/subdlv <br />OWNER NAME: °'] � <br />OWNER MAILING ADDRE? <br />OWN�R PHONE: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRE65: <br />87REET <br />RfTY <br />1 l �� <br />81'r�eer <br />� <br />CIT1' <br />CONTRACTOR PNONE; � - ` C <br />CONTRACTOR LICENSE #(R�QUIRED):� <br />PRIMARY CONTACT: ❑ OWNER <br />CONTACT NAME: �� ��� <br />� � <br />fln <br />PROPERTY TAX #: <br />No, (atlech capy of long leggl desCrlptlon) <br />TENANT NAME (If Commer�ial): <br />OWNeR EMAIL: <br />STASE <br />STATE <br />YIP <br />zlp <br />CONTRACTOR EMAIL: � ' <br />V� I� GITY OF EVERETT BU91NES9 LfCENSE i1�RE0lIIRED) <br />R l� OTHER (Please Speclfy) <br />CONTACT PHONE: �.�..�� a �O� ��.� <br />CONTACT EMAIL: �'1/1Dtl „I'��.L� /�l,nl�0/a-r�d1 �2 rd� <br />Ca�tract Prlce of <br />4�ro osed Use of Buildin ; Heat Source: as ❑Elgclrlc ❑O#her <br />�ulldln T o: 5FR-Detached ❑SFR-Attachecl ❑Du �ex 4Mulff-Famlly� of Unita: �Commercial ❑Industrfal <br />�Type of ProJect: ❑New ❑Addltlon ❑Remodal ❑Repalr ❑T,I_ ❑Si n ❑S rinkler ❑Demolltlon ❑Chen e of Use <br />DESCRIPTIOAI OF WOItK: <br />�� , .`� �. , G�� t�' � � ����"� . <br />��5 �'�=� <br />A330CiATED BUILDING PERMIT # If a Ilceble ;� � O �(7%% <br />�`� � ' '� �,. '.� �,,. , <br />, .\�'` <br />Type ot ProJoct: �,Naw � Addn _�llt�rallon _�iepalr <br /># or L/sr orFlxrures � of <br />FfXfurea Flxtures �lat Of F/xturea <br />WC — Alr Handlln Unity Meat Pump <br />Forced Alr S stems <br />Ges Plpin <br />Weter hfeatar <br />Oas Flre lace <br />Gas �an e <br />Clofhes Dr ar Hook� <br />Ren e Hood <br />Exhauat Far1 <br />rti.^r:>1 3` r•. ' . . _� <br />0 <br />�vumver or neaas <br />4CKNOWLE�GEAqENr ! havs ravlewed fhla appfic�tion and conllrm fhA /nformaUon conCsfned hereln la true end carrect. work dane purauent to lhis perynil must oompry w17P� <br />:urrenf fBderal, 6te16, and local lew. Trra gra��fna of a perm/t only authorJies epproved wark end no devlatlorts fhere/rom, Devlailons must i/rsi be authorized fn wrlrrng from rhe <br />9ul/dln� 011lc/a! bafore being euthorizad u��de� eny c/.numetance, 1 sm �hA awnsr, or l em eu�horized by fhe owner ol thls propeny to perform the work far whlch eppflcarlon Js mnde, <br />and I comply wHh tho Sfate Con�rectars Lew �6, 27 RCW entl 296.200A WAC. <br />Cltyof�ve�ett Ofllclal Use O�IIy <br />" I PE IT � <br />' V� I — <br />JWnor/Authorl�ad AgenY Slyn lur� bst (ReNsed 2 9B) <br />