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d5/i0/20i7 wED 11: 2� FAx Fa�t water H03tOr �ppz/flp2 <br /> �(�' l�L' �� <br /> PERNII�'APP�.ICATION <br /> . BU1LplN� /MECHANICAL I PLUIUIBlNG/SIGAI 1 SI'RIN6C�.�R!4�MOLITtOM <br /> CI7Y QF CVERE77 P�RMl7 S�RVIC�S <br /> • 3200 CEDAR STRE�T,�V�R�77,WA 86209 <br /> (P)425-257-00'!0 � FAX 426-267-8fi67 �(�)everetteps�evarellwt�.eov� www,evereFtwa.gov/permlts <br /> Blue or�ilaak!nk OnI Piease) PROJECT$IT61N��RMATyaN <br /> PIZOJ�CT 91TE ADL1RE89: o�t I� �� � W 1 U� pROP�f2TY TAX#: O �D 0 D '\"� <br /> �EGAL for naw canstructlon: 5nort PlaVaubdNtslon Lo[Na,"_ (�ltach capy oF long teeal daecdpUon) <br /> CONTACT INI�ORMATION <br /> OWNER[VAME: TEtvA[VT NAM�(lf Commerclaq: <br /> OWN�R MAILINC ADaFi�SS: srRe�-r � �- <br /> ctrr � srn� � zir g <br /> QWN�R PFfON�:�� � OWNER EMAi�: --.—_, <br /> CON7RqC701i NAM�; '� S`� <br /> CONTRACTOR ADDRES9: erReer � S <br /> cm � � � sYnrE ziv � <br /> CONTRACTOR PHOf�fE: ��s C GONTRAC70R�lUlAll.: ��,VY1�TS }"� �e/}r, <br /> CONTRAC7qFt l.IC�N$�#(R�{2UIRED); �"r'w N' G CITY bF�V�RETf BUSlNESs LIC�NSE#(REQUIR�D):� <br /> PR[MARY CONTAGT: I�QWtV�R CON'tFiACTOR ❑OTHER(Pt�esa Speclfy) <br /> CON'CACr iVAly1�: CONTAG�PHO�IE: p�� <br /> ��� ���� GONTACT�IVIAIL: Q�1(Wl�li S cS�' -�P�/'. G�� <br /> Bl11LD1�1� P�F�IUIIT�APPLICAYIbN <br /> � ExiBtin Use of 8ufldin : ConEract Arica ef Work: � <br /> pro asetl Use of Sullding: Heat Source: as ❑El�ctrfc 40ther � <br /> Builtlin T e; ❑S�F��qetaChetl C�SFFt-Attached ❑Du fex ufthFsmll -#of Unfts: OCommerolal Cllndustdai <br /> T e of Pro'ect: C7NeW �IAddltlon qRemodel R� aIr �T I. I�Si n �5 rinkler ODemolftlon ❑Cltan e of Use <br /> DESGRIPTION 0�WOIZK: <br /> �iM p�� � �2,��G`�� ��S w o�-�� ��a,fi� ; <br /> AssoCIAT�D BUILpING P�RMIT� If a Ilcable: <br /> (IA�CHANI�A6 P�RM1T APPL.IC�LT10A1 i►l.UMBIN� ���IVII'1'APRLICATfON <br /> rype of ProJcol: _New_ addn _Alferation _�palr 7ypa a!7roJect; �New ,,,^pddn �11Raratia� ,_Rapa� ' <br /> p��� l►et of F7xturea ���r g Llst or Flxluras Flxtures Ltst af�Ixture9 ��u�8 Clat of F� roa <br /> A/C�Alr Nandlin U�ite Heat Pum Tall Baakflow Prev r Inelde BId I <br /> � Forc�d Al�S 9teli'Is tJ�lf Fl��f�r thiub Urfna! � <br /> Gae Pt !n Bailer Lavalo Wash BasU Drinkln ountaln <br /> Wafer Heatel' itefrl eratlon 3hawer Floo raln ; <br /> oas Flre I�ce Wood Stave Klichen 51nk 8 Dla osei ease Tra � <br /> Oas Ran a Dactln l7lehwashar R Dralna � <br /> Clothea D er Hooku a Olher. Clolhes Wash�r. A�ed I C��a � <br /> Ran e Hood atet I-leater Other. <br /> �xh�ust Fan Sln o etC. Other: <br /> $I��t1N E:�8810 IVI i <br /> emlaal or W .of Heade � <br /> ACKNpwIEapEMENr�/have reWawed thls epplMallon and conllmr fhe Jnfamallan conla�ned here/n la lrue and corrscf.Wwk done purauant to Ibfs perml�mual canply wlth : <br /> current fedarel,sla�e,entl looa►law.Tlie granfing of e pormP!only oullrorlxes approved worh end no dav�allona fhwehvm.Aevlallona must Rrs!Bm aufAorizatl!n wr1NnQ llom fhe � <br /> 6[dltling oNAola1 Ls/ora being aufhoilPed under any clrtiwma�ance,I em fhe own�r,or I sm eathorized by fhe owner of�hls proper�y 10 perlorm!he wnrh/or whlch epplkeHon Is matle, <br /> end!comA�Y�fA ths 51ete Conlreofors Low 7da7 RCW and a9�2aaG WA� <br /> G oI kVe1'eft o7lc/e!Use Only � <br /> ���D � ( P � �� � _ OZ� � <br /> Own ulhor ze Ag �9lgnatura Oate (Ravlse4 8/23P1o76) <br /> � <br /> � <br />