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05/18/2p16 wEn 13:39 FAx a25 252 1666 CM Heating f��01/V02
<br />• PERMIT APPLICATIOf�
<br />BUILDING / MECHANICAL / PLUMBING / S1GN I sPR1NKLER 1 DEMOLITION
<br />GITY OF EVERETT PERMIT 9ERVICES
<br />3200 CCDAR STREET, EVERETT, WA 982D7
<br />(P) 425-257-8810 � FAX 425,257-8867 �(Ej everet#epa�evereltwa.�ov � ww�rv,ev�rettwa.qov/permits
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<br />LEGAL for new aonstructlon; 9hort PIflU6ubdlvls{on Lot No. (attach copy of long legel desorlptlon)
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<br />OWNER NAME; TENANT NAME (If Commercl�l :
<br />OWNER MAILING ADDRE88: 9TREET S�
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<br />c�„� P��,� a'� sTaT� � Z�P �
<br />OWN�R PHONE: �
<br />CONTRA�TOR NAME�
<br />CONTRA�TOR ADDfiES9� STREET
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<br />CONTRACTOR PHON�: (
<br />CONTRACT�R UCENSE #(R�QUIRED)
<br />pRIMARY CON7ACT: ❑ OW�ER
<br />C N7ACT NAME: � '
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<br />Exislin Uae of Bulldln :
<br />Pro osed Uae oi Bulldin :
<br />Bulldln T e; ❑SFR-Deteched
<br />s of Pro ect; ❑New dltlon
<br />DESCRIPTION O� WORK;
<br />i��Cs�
<br />A380CIATEA BUILDING PERMIT N (It
<br />R eMAi�;
<br />9TATE
<br />7U CONTRAGTOR EMAIL: 1
<br />� � CIl'Y OF HVERETT BUSIN[99 LIC�NSE
<br />R ❑ OTHER (Plaese SpeClfy)
<br />CONTACT PHONE; � at �
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<br />CONTACT EMAIL: (� ,
<br />,� � , �UILDINO;�ERMIT�AP,PI.IQAT,ION'","' . ,� , , ' �' �';"' '
<br />Contract Prlce eP Work: $
<br />Heet 5ource: s ❑�leairlc ❑Olher
<br />R-Attached ❑Duplex ❑Multl-Famlly� of Units:�_ ❑Commerclal ❑Industrlal
<br />❑Remodel ❑Repalr ❑T.I, ❑Slgn ❑5prinl�ler ❑Demolltlon ❑Chenge of Use
<br />ACKNOWLEpQEMEN7: I heve revlewaa fh19 Opplfce[!on end conlhm the IRformafion oonfafned heroln fa frLe Bnd correot. Work dane pursuanf fo fhls parmlt +�tGSr Cemply wlfh
<br />curran( federal, state, end Iocal lew. TAo granflny of a permit only aufNarizma approved work a+�d no Cevletfone �herefrom. DevlaHons must flrst De Aulhorized In wr!(/n� ►ram fhe
<br />9ulldlnU ON1C/oJ belore beln9 evfhorlred und�r any clrcumstance. ! em ihe owner, o� 1 em eulha�lzed by the owner ol th/s property to perforrn fha work fnr whlch eypllcell�n !s medv,
<br />end f oomp�y wtin tna Stata Contractors Law 1 B, 27 Rcw d 298.200A WAC.
<br />Cky of Evereff Offlclal Use �nly
<br />I �� PERMIT #1 /�, /1 I � _ �i ".�
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<br />Owner/Authorlxed Agant 9lpnaturo Date (Revlsad i 1 0!S)
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