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08/34/2016 TUE 10:93 FAx G25 252 1666 CM xeating [�002/003 <br />� PERlUIIT APPLICATION� <br />BIJILDING 1 IUI�CHANfCAL /�LUMBING / SIGN / SPRINKLER / b�IVIOLITIpN <br />CITY pF �'VERETT PERM17 SEF�VICES <br />3200 CEDAR STREE7, �VER�TT, WA 86201 <br />(P) 425-267-8890 � FA?C 425-257-Bab7 �(�) everettepe(�everetlwa.gov � www,everetkwa.8ovlpermlla <br />{8�'�i'�; ��r!���i� � �+In4�,',dnl�':��� �a$�a� ���iQJ�CT;$I�8`''l�FQ�lldrj,T�6N�> � �,. <br />PkOJECT SITE ADOF��S3� PROPERTY TAX #: <br />LEf3AL for new conatructlon: 9hort PfaUsubtllVl9loh Lot No, (ett�Ci1 oopy af lonQ lagal deserlptlon) <br />� � C�?��''�1�'`X':'N�l:F�"� AY�G�N � <br />OWNER NAME: -i� 7ENANT NAME If Commerclal); <br />OWN�R MAILINC3 ApDRE&S: sTR�er , <br />CI7Y STATE � ZIP Z� <br />OWN�R PWON�; OWNER EMAII.: <br />COM7RACTOR NAME: <br />CONTRACTOR ADDRE8S: srR�eT � <br />c�TY srnTe � zM �� <br />CONTRAC7'OFi PNONE; CONTRAC70R EMAIL: a��Yj <br />CONTRACTOR lICENSE #(REQUIRED}: �� �� CITY �F EVERETT BU91NE99 LICENSE #(REQUIRE�); Q�� <br />. . . . . . . .. . . <br />PRIMARY CONTACi: ❑ OWNER CONTRACTOR ❑ OTHER (PI68sA Speclfy) � <br />CONTACT NAME: �,��% l�� #'� CONTACT PHON�: .� � C�, O <br />� <br />� ah�'��� �'�- CONTACT EMAIL; � � � � � <br />- ,, �,�;� ,��';� ,,. ;;, y�Q�I�"�' �.1� 1�A ' M.� �'�. j , ., . , <br />Cxletin Uee of Bufldln ; Contrect Price of Work: $ 0� � <br />Pro qsed Use of Bufldln : Heat Source: as ❑Electrlc ClOther <br />B�ildln T e; 08FFt-Deteched ❑SFR-Attached �1Du lex ❑Mult1-Famll -# of Units; ❑Commerclal ❑Indusirlal <br />Type of Proect: ❑IVew ❑Addltlon ❑F�emodel ❑Re alr ❑T.I. ❑5i n ❑3 rinklar �Demolltlan ❑Chan e of Use <br />DESCRIP7lON OF WORK: <br />� <br />����11 � �s �P i►� ��..�- �- �10' o� �� aPlr� <br />� � � <br />� . <br />A38oC1ATED BUILDINO P�f�MIT # (If enolicableL• <br />ACKNV WLEOGEMENT.� ! have revl�wed thla appl;catlon end con//rm Ihe Informaflon conlalnad hal�ln is true and oorrect. Work done pursuant to fhla parm/f musl comply wlrh <br />cument tederal, sfete, nnd locol 1ew. 7h6 g�an1ln� o/ a parmft only aufhorizas approved work 9nd no devlatlons thel�elrom. Dev/a�fons musf h�rsi 6e aufhorized fn wrlUng lrom �he <br />BuUdlnp 011lc/al8afera boing euthorized under eny clrcumsfsnce, ! am [he ownar, or I�m au�horizad by �he owner a/ �hls prope�ty fo per/orm the work for w1�lch eppiicarion 1s made, <br />end � comply wlfh tha Stele Contrecfors Lew 18.27 RCW end 2g8,200A WAC, <br />CIty ol Everett p/flclel Use Only <br />• V�� I�Q PE �# �O "_O"l `l <br />Ownar/Authorlted Apent 91pn turo Dete Ravrsed 6�20/2016) <br />