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O�IO3I2O18 TUE 11: 12 FAX 425 415 6867 Fa�t WAt�Y H�dtpY [�pp2/p03 <br /> p�Ftlllll'T Al?P�.IC�TtON " � ��� � <br /> �UILDll�1�/M�CMANICAL/F�ILUM�ING/SIGN/S1'R11��LER/D�IV104.tTI0N <br /> CITY OF EVCRE'T"f PERMIT 6ERVICGS � . <br /> 3200 CEDAI�S71�'L-'�"P,�VERETT,Wl�l 88201 <br /> (P)k23-257-(3810 � FAX 425-257-8857 �(�j evereEt9psQa ev�reLtwe,gov� www,evel-ettwa.gov/p6rrnita � <br /> �Yeae�r�l�c�c ��tc�nay Pl��se �9�Q.��ChP S�T���DIFOf�M�4M0�1 <br /> •nRo��cr s1'r�AI�uR�ss; 5 � T PROI�ERTY 7A?C#: O � <br /> L��a,AL Por new constructlon: SAort PI�UsubdivlslorL, Lol No.�,_ (atlach capy af long I�gal d�sarlptlon) <br /> COA�1T�i�T INFOSZMATION <br /> OWN�R NAME: TENANT IVANl�(lf Commerclal); �� <br /> OWiV�R MAILlNO ADDRE99: srnEFr a so5 � � � <br /> rfTY 97wTL� 31P 3 <br /> OWNER PHON�: 'J�' � OWNER�MAIL: ,�' <br /> co�v�r�cr.o�t t��,mG: � S`� � T � <br /> C�NTRACTOR ADDRESS: srqEEr �'� � <br /> cm' D' � � arn-rE YIP � <br /> CONTRACT01�phlONl�: �o�5 CpNTRACTOR�Mf�lL; R,VI�1 ITS �I,IJ -�f/�, <br /> CONTf�ACTOR LtCEN9E#(R�QUIREb): s l)� �jL CtiY OF EV�R�TT F3USINEs9�ICefVSL�(ReqWRED) ��3 <br /> .. . .. . . . . ... . . . . . . . <br /> PRIMA�iY CONTAc"f: ❑OWNER CON7RACTOR 0 OTHER(PleaeB 5peciFy) _ ___ <br /> CONTACT NAME: �/ �ONTACT PHOAI�: ��� <br /> 1��� ���", �� CONTAG3 EIUJqIL: �,1-� � �• �yy) <br /> � BUQLIDIM� IP�i�Ml1r,AIPw�rc,pYloW <br /> � ExtaEfn Us�of Bul[din : " Conxract prica Qt N/ork:� �" <br /> I�ro osed Use oFk�ulld�n : � 1-IaatSource: as ❑Electric l��ther � <br /> Buifdin T e; R-Datached �SFR At#ached Clpu I�x �1Mu�d-Famll �OP Uplts: ❑Commercla! Dindustrfa! <br /> Type of Pro'�ct: DIVew QAddition �Remodel Re alr �1T.1. I751c1n CIS 1lnkler Cldemoiitron �Ghange of Use <br /> D�9CRIPTiON OF WORK: . <br /> ��rn �v� � ���1�C� C�S w�-�-�'� 1�,�a,� <br /> ASSOCIAT�q�UlzDfiVG p�RMIT# ff ap IICeble� <br /> M�CHANI�AL P�RMIT APPLICATlON �X.lJ�BlN� p�RIV�pY APP�.1C117'IDN <br /> lype oP ProJvcE� �Isw_ Addn _Alteratlo� _Repalr 'Iypa of Pro)eat: _Waw ,�}lddn ,_Aitarallo� ��iape�ir <br /> ��u� ,L/st'v/F!xlur�s F/�u�s Ll9t of Plxtu�res Wx u� LlsE ot!-7xtures �Jxtures Lfst of Plxtu�o� , <br /> A�C W Alr Mandifn UnEts H�at PUm 70ilet ��Ckfl Praventer l�sfde Bld I <br /> � FoPced Air S st�ms IJnIt Heater �&tFitub Url � <br /> ` Gas Pi ln 8o!!er l�av W�sh Basin nkln F'ounteln � <br /> Water Flea6er �tsfrE eratlon S wer F[oor Dfairt � <br /> dea Flre Ipce VVood Stov� Itchen 3ink&bls osal Orease Tra � <br /> Gae Ra e Quctln Ishwsaher Roof Oralna <br /> Clothas D er Mookups Other: CI ae W&aher Medlcpl Gas � <br /> Range Hood WateT tar Oth�r: <br /> Exhausl�an Sf cg tc. Other: <br /> Sp�lN QSSCO IU� � <br /> emlael or W .of Heads ` <br /> ACKIVOVV[,�DG�M�nl7:J Rave rovfewetl Urle appl�affo»and caMtm tha lnlbmrsNan con(elned here/n/s[r�ue ar,d correct W{ork done pursuanf fo fhls panr,lt musl comply wkh <br /> cur,�f letlerel,stet�and bce!l�w.7'he grenffnp of e permlt oMy euthoNces approveU work�ntl no dev/allorre fhvre�Yam.Pev�a�lone n7uet prst be eulhorized In wrltfng rrom�He <br /> earlu�ng olticlsl Deroh�6vinq euNrortzed unaer�ny olrcuttrstanca.I am fhe awner,or!em aulhorizad by the ownar of�RIe property!o peri�nrm lire worh for whlch appltcaflon(s mad�, <br /> and/comply wlrn fhe Slefe Confraoior�LeW 98.27 RCW end286.200A W�G. <br /> C/ry o/k'4�rrott olY7ore�use On1y <br /> � � ,�I � PE I • <br /> •-- <br /> Own uthorae Ag Signatul�A Oqpy . (Revle�9d9/23/2016 <br /> . � <br />