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09/2g/2p17 THU 9: 99 FAx Faet water xeater I�003/045 <br /> � � <br /> PERMI'T APP�ICA�TlON �O� ��� <br /> BUlLDING /N1�CH�lNrCAL/��.UMBIN� !SIGN /SPRIIVKL�R 1 D�MOL.tT(ON <br /> � CI'�Y 01=EVERETT PERMIT BERVICES <br /> 320a C�nAR STRL'-ET,CVERETT,WA 06201 <br /> (P)425-267-88'10 � �AX 425-257-8857 �(E)overaEtep$�everellwe.gov{ 4wwv.everellwa.�av/pormlts � <br /> Blu�or�1���c Ink Oni �le�se FROJI���Sl�� lN��ttMd1TIOF1 � <br /> PRO.IECT S17�Apf�RESS: PROPERTY TAX#: t� � <br /> L.�GAI.Por new conatructlon; Sh�ort PlaUsubdlvlslon Lvt Nv. (ettad,copy oF lar�i�gal desarlptlan} <br /> CONT�ICT fNFO[iMATIOIV <br /> OWN�R NAME: TENANT NAM�(If Commerclal ; <br /> OWN�12 MIAILINC ADDl�E55: arnfier L <br /> Cm BTATE zIP <br /> OWN�R�HONE: OWN�R�iVIAi�:�— <br /> CONTRACTOR NAME; ST � T <br /> GON7fZ4CTOR ADDR�SS: atxeer � s � <br /> ��. � � sT�� Z�� 1 <br /> CONTRAC'fOR PMON�: ��s CONTRACTOR�1VIAll: ��,II� ��S �U.J �'P/I�, O <br /> CONTRAC7012 UC�NS�#(REG1uIR�Dy:� -5"j`w � �� C1iY OF�VERGTT aUSINHSS LIC�N5��l(RI�QUII�ED)• ��� <br /> pRIMARY CONTAC'r: ❑01NN�R CONTFZAC70R ❑07H�R(Ple4so Sp�clPy) <br /> coNYACT NAM�: couT�cr nHONE: �o?� <br /> 1�r� 1`��I �� CONTAG7 EMAIL: �,1� � �, �� <br /> BUILDING P�RMI'T APP6ICA�ION <br /> `/ �xlstin Use of Bulfdln � " Contiraci Pfioe of Work:$ � <br /> ,� �Pro osed�lsa of Bulldi : Heai Source_ L"7Gas lectrlc ❑Other <br /> Bufldln a� PR-Datachecl �SFR-Attached ❑Du lex ❑Muft!-Famll �of Units: (�Commerclal C1G�dustrlal <br /> 9 of Pro ect: Cl�few DAddltlon ❑Remoclel Re afr ❑T,I. ❑5i n ❑5 Nnklef QDemollCion �1CI�an e of Use <br /> p�SCRIPT10N OF WORK: <br /> �iM p�� l �2,�\�lG� ��-�G��Y i � ����� � �GL,�� <br /> AssocraseD BUI�bING P�12MI7� IF� Ilcable: <br /> IIII�'CHANI�AL PBRMIT APPLI�ATION �i.lJM�lf�@ ��R[V�A7 APP'�ICA7'ION <br /> 'type of ProJsat: „_,_New ^ Addn _Alteratlo� _ alr 7ypo of Pro�aat; Naw �4ddn �lteraflon _,,,Rc+pair <br /> Flxturas $ Fl�urey Ll of Plxiures F�xtures �lat of�Ixturas �r��� L/st o�Flxturos � <br /> C--Alr HancllEn Unf al Pum �T'oll�t BaCkflow Prevanter fnsld9 Bld � <br /> � Fofced Air S stema Unit Heater �2thtltb Urina! <br /> � �ae PI In BolleC Lavato Wash Besln Drinklh �ountaln � <br /> Wafer hfeater Refrl erst►on Shower �loor Dratn � <br /> aa Fire face ood 5tove Kltchert SMk&Dle oeAl flrease Tra � <br /> Ran a D tn DIehW9sllo� Roof Dralns <br /> Clo es D r Ho a othe. Clothes Washer Medlcel oas I <br /> �a� Wafer Heater OthO�: <br /> �xhaust Fan Sink Service/��dMo /eto. Othor: <br /> ,SPRIM �SSI� M � <br /> �mlcal or .of Head� ' <br /> AClWOW�EDGEM�NT.��heve re�lewad thls appllca0on and canR,m fhe lnfo»n�flon aonfalned�erelnls frue and cor�ect.Work done pu�suent lo N,Is pennit must comply wlth <br /> curren�federa�stat�,end loca/law.THe prenf/ng of�perm!!onry eufhorizes epproved wwh and no devlal/ons lHarefrom.D�W�llons must lirsf De aulHorl�atl/n wrlting hom the <br /> �ulhling O/ifcle!befors belrrg authodzed under any dicums(enca I a1m!he owner a'1 am ilufhorfzad by the awne�a1 thls prape�y lo perform fi�e worh forwhlch sppllcatlon!s m6de, <br /> and!aomply oNth fBo Sfa�e Gbnlractas Low��27 RCW and 28&200A WAC, <br /> CIIy of Evere$O/ikle/Use Only <br /> "(-��- / P�`�/I�# '� o <br /> � � � <br /> own ufhorze pg s�gnature Date (Revsed 10) <br /> , • <br />