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1�/30�2�17 M�N 15: �2 FA� Fd�t water HOdtp1 ���3/�Q$ <br /> � �p03 $ <br /> P�RMI�A�PLICA7'!ON <br /> BLiILDING /iV1�CMiANICAL/P�UI111�1NG /SIG1111 S�R�NK�ER/ DEMOLITION <br /> C17Y UF CV�RCTT PCRMIT SERVECES <br /> 3200 G�DAR S71���T,CV�RETT,Wl�98209 <br /> (P)423-257-8810 � FAX 425-257�8857 �(E)averettepsQ9v�roUwe.gov� wu�ri.evere(lwe.gov/permlte <br /> BIu�or B�ack I�k�nly P�ease PIROJ��CT SM�� MR�FOd�MA,1C�0�1 � <br /> PROJEGT S17�Aapf71�S3: �Z � PROP�RTY TA)C�#: p� � <br /> L.�GAL.Por now construcUon: Short PlotlsubdNlslan Lot No. �, (attach copy of fong legal tlsscripCon) <br /> CONT�ICT INPORMATION <br /> OWNER NANiE: � S � TENANT NAME(If GommerCl21)� <br /> OW�l�I�MAILIIVCy ADDRESS: s�rt��r <br /> Cf1v 9TnT� ZIP <br /> OWNER PFIONE: OWN�R EMAIL.: �—� <br /> CoN7RAC'fOR NAME; � S� '"� "r <br /> GON7RAGTOR ADDRE9S: arReer I � S <br /> CTTY � � ^ 97A� ZIP I <br /> CONTRACTOR PHONE: ��s CONTRAGTOR EMAfL: ��,IM IT S �'U�J -�/Y, <br /> CONTRACTOF�LIC�NS�#(R�QUIR�D):� S'"r �`� �� CITI'OF EV£'RETT HUSIfVE6S LICEFVSE#(REOUI{�0) ���j <br /> PRIMARY CONTACT: ❑ pWNER CONTRACTOR �7 OTF{�R(Pleaee Sp9C�Py) <br /> GoNTACT NAML: CON7AG'f I'WON�: ��'S <br /> ��"r� ���v� CONTACT EMAIL: I��,+-�-5 -1-� ..4-�/'� �� <br /> Br1iLDYN6 PLRN117APPL1CL1T10N <br /> � �xlstin Use oP Bulldln � M " Contract Prfce ofi Work:9i � <br /> Pro ased Usa of Bulfdin : � Heat SOuroe: Oas ❑�leCtric ClOther � <br /> Bul[dfn pe; �SFR-DetacherJ OSFR�Atleched �Du lex uftl�Famil �of Uhlts: C�CommefClal Cllndustrl�l <br /> e Of Proect: CINew C1Addltlan ClRemodel Re afr ❑T.l. ❑Sf n �5 rinklar D�emolitfoll ❑Ci1ar7 e of Use <br /> a�SCI�IPTIONI OF W�K: � �� �� � � �a�� a� <br /> �V Y 1 O � `� V �� W��`-� 0 V L �i <br /> A950ClATHD�U I�t71NG P�fdM1T# If a licabl0: <br /> 1V��CNA�11C�1L P�RMIT qPPL1�AT10N �LUMB�N(�i P�R�V[�T�A�PRlCI#'1'I�N <br /> 7ype ol Profeak �J�faw _ Addn �Itaratlon „_._R�pal� Type of Pro)ect: ___,New _�Lddn Altaratlon _Fiepalr <br /> �Ixiurea usfof�lxtures Flxtt e9 Llst�Plxtures �x u� Llsf afFlxtl�Yea y�u Qs LlstofFlxt es i <br /> A/C—Alr Handlin Unfts �leat Pum Toilat BackPlow Preven Inslde Bldg) <br /> ForcedAir s stems Un f Heafer �athriib Urinel <br /> ` Oas Fl 1n Boller Lavato Wash 13asln rink[n Fo taln � <br /> Water He�ter Refrl eretlon 5ho r � r D <br /> Oaa FUe lace Wood Stove Kftc en Slnk&Dla osal Grea Tra � <br /> Gae Ran e Ductln 171s waehar R Dr a <br /> Clolhee D er Hooku a Other: CI hes Washer edlcal Ga i <br /> Ren e Fiood W ier Heater Other: <br /> �xhAuat Fan sfn Setvice/earlMo /etc. Other: <br /> SP�i1N �S3I0 1FS'i'�M � <br /> emlc�l or ,of Heada <br /> a CJWO WLEOGEMFNT°/heva revleweQ thla eppllca7lon end con/r.m t/!a/nrormallon oonta�n�tl nerre/n!s lrwe ana correcL Wak done pursuan!lo fhls parmlt mus(comply w�th <br /> currgnf federel,stalo,e+�d locel few.7he aranf/ny of�permll only euthwlaes spproved work a�d no davlaflona lhereiYam.Devlaflons must//Yst De mufNorf�atll»wrlring hom i�a <br /> Bund�ng Olfkla/beh�re being eulhorized under eny c/rcumatanca!sm tHA owner,or!am trutkoYPzed by the owner ol�hly p�opedy!o pedarm the wvdr far wh/ch eppUcs�lon!S made, <br /> antll comply wlln�ne Slate Confractora Low�g,g7RCWandzeazooA W,4c, <br /> C1fy of�reipf�Orylcls/Use Only <br /> ��� ao � �� PER T ' i �f C�l.�!/ <br /> ✓ <br /> �wn r utnorze Ag 3lgnaturQ DaEa Revse 3/209 <br /> ...�—_,_�._�__._-�..—_._ ' �._ . <br />