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10/13/2016 THU i9:z1 Fax a25 252 1666 CM Heating I�q�a/003 <br />� PERMIT APPLICATIO� <br />BUII�DING ! MECHANICAL / PI�UMBING / 51GN / SPRINKLER ( DEMOLITION <br />CITY OF EVER�TT PERMIT SEF�VICES <br />3200 CEDAR STREET, EV�RETT, WA 98201 <br />(P) 426-25T-9810 {�AX 425-257-8857 �(E) evsrettepe@everettwa.gov � www.ever�ttwa.govlpermlts <br />(�ue aw �la�k Ink bnly I� ea$� �Itli.��CT $��':� 1 FO � MAT10N <br />PROJECY 91T� ACDRESS: L� PROPERTY TAX #: <br />LEGAL for new conetructlon: Short Plar/subdivislon Lof No. (altech copy of long legal descrlptlon) <br />� � CVNTACt iwFOl�t�bYlb� <br />OWN�R NAME: TENANT NAME (If Commsrclaq: <br />OWNER MAILING ADDR�BS: sTREEr ��Q j� �� <br />C� STATE ZIP <br />OWNER PHDN�; � � �OZ �.� OWN�R EMAIL; <br />- . <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: sTaeer � �} <br />CITY STATE � Z(P � <br />CONTR�4CT�R PHONE: CONTRACTpR EMAIL; > ,��� <br />CONTRACTOR LIaENSE #(�2EQUIRED);�{ �� n CITY OF �VERETT BU6fN�SS LIG�NSE #(R��UIREI]): �(� <br />PRIMARY CONTACT: ❑ OWNER CONTRAC70R ❑ OTHER (Please 5p�elfy) __,.� <br />CONTACT NAME; �� ��� CONTACT PHON�; � � `—C� � <br />� ` � CONYACT EMAIL: � �'(r� P �(�j� <br />, , , - � �� ,. � � � . , . ���, .,��r�� ���� r� ����;'��: �� .�+Q!;:, <br />Exlatln Use of Bulldln ; Contract Price of Work: $ �I �I �� <br />Pro osad Usa of Bui dln : I�eat Source: ❑Gas lectrfc ❑Oth�r <br />Bukldin 7 a: FF�-Datached QBFR-Aitached Qpu lex ❑Multf-Femi) -# of Units: ❑Commerclal ❑Industr�al <br />Type of ProJeat: ❑New OAddltlon �f2emodel ❑Repair l]T.I. ❑SI n ❑S rinklor CjDemolltlon �Chan e of Use <br />D6SCRIPTION OF WORK; <br />ci1 1�I W"'. T7 7" /r 1� ''� <�a`'L-l.� �1��L.� w�� <br />ASSOCIATED BUILDINO P�RMIT i� If a Ilcable : <br />� l.',�II�\+f. , ���Y. . / i II � :' - S ll A' <br />S' �. .��1 ��. �i`��i <br />Type o/ ProJ�ct: `Naw Addn Alteratl0h _Rspalr <br />� of L/s� Of Ffxteires � 0� <br />Flxfurea F��u�.�a LlstofPlxture� <br />A/C — Alr Handlln Units � Heat pumn <br />e <br />��' *r �l� � �„rr� �a�Fur}I;Q�:Tt��: ; �t,p;. <br />um er o Hea s <br />- .��� <br />ACKNOWLEpp�I�qENT: ! hava revJewed �h/s appllcaf/an and canlJrni fha Inlormatlon cantelned hereln la true �nd corracl. Wak done pursuant to Ihls permlt must compty wNh <br />currenl tederal, state, and loca!lew. The granting ol e perm/t on�y auihorfzas app�ved work and no devleilone tharelrom. DeWeflons musl O�st be aufha4zadli� wr1(!ng /rom Ine <br />Bullding OA7cle1 bafare being au2horized undsr eny circumatence. 1 em the owner, or / am aufhorized by fhe owne� of Ehis property fo pe�form t17a work far whlch eppllcetlon Is made, <br />and 1 canA�y wlth fha Stete ContrsCtors Law i8.27 RCW end 286.200A WAC. <br />� Clly ol�vsrak Offlclal Use On�y <br />' ' PERMIT # ;/� n � �Q � Q� <br />l0 I 3 � Y ;� �, <br />ownerlAuthorized Agent 81e� turo D te Revlsed �20/209G} <br />