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02/08/2017 13: 23 13604283374 N4,) ,_1; ELEC TNT) JATC PAGE 01101 <br /> PERMIT APPL-IC==MDN <br /> OUIIR0lG /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERET7,WA 98201 <br /> (P)425257-8510 I FAX 4257257-8857 1(E)everettepsCaverettwa.gov I www,evereUwa.gov/perniIts <br /> PROJECT SITE ADDi2E83: '^� .7� �'I Gty !`.X�!-i Vim. �v,Gr.t-7fI in/�i �(�2�J PROP1rRTY TAX#: <br /> LEGAL for new constructfpn: Short Piat/sul3divislvn Lot No.,,,4, (attaQh Dopy of long lege!description) <br /> OWNER NAME. c� � SY i�v Coit TENANT NAME(if Comrnarcitl): <br /> OWNER MAILING ADDFRES$: STREET �Z'2I J���,r/t�e�vi �/e✓ � / <br /> CITY v�,,,y/�/( STATE k! ZIP <br /> OWNER PHONE: ��5 ZSgl `tS��l OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> City STATE zip <br /> CONTRACTOR PRONE; CONTRACTOR EMAIL: <br /> CONmttyxo­TRACTOR LICENSE#(REQUIRED): CITY OF EVERETr BUSINE43 LICENSE#(REQUIRED)., <br /> PRIMARY CONTACT; OWNER ❑CONTRAMFOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> Existln I g Use pf Building: Contract Price of Work: $ DU <br /> Proposed Use of <br /> Building:-Ho-?it Source: ❑Gas ❑Electric E10ther <br /> 13u.ild ing T e: ❑SITE/-Qatached gSFR-Attached CIDU lax ❑Molt[-Pemil. #of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New 1JAtlditlptl .]Remodel ORe air OT-1. O' Stn �5 Mnkler <br /> DESCRI lON OF WORK: Demolition ❑Chan a of Use <br /> ASSOCIATED BUILDING PERMIT# ifIlcable : <br /> Typo of Projeet: `Now AddnIteration <br /> Repplr Type of Projegt: —Now _Addn _—Alteratign R®pair <br /> l let of Fixtures #°f #of #°f List of Fixtures <br /> Fbrturas Fixtures Llst ofFlxture� 1�71artltrea LJstof ftfures <br /> A/C-Air Handiin Units Heat Pump oilet FJxrures <br /> Forded Air S tems Unit Heater sa#htub Backflow Areventer Inside sld <br /> Gas Rlpin aoiler rival <br /> Lavato ash Basin Drinkin Fountain <br /> Water Heater Re i eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink Dispose/ IGrease Trap <br /> Gas Range Ductin Dishwasher <br /> Clothes Dr Hookups Other: Roof Drains <br /> Clothes Washer Medical Gas <br /> Ran a Hood Water Neater <br /> Exhaust Fan Other: <br /> Sink ervlcelBar/Ma etc.) Other: <br /> s <br /> Chemical or Water <br /> No.of Heads <br /> A rranf od"I,GFMENn;t have aw.Thed this appli'catfon ant conFrm the information opntained herein f9 true and co"rt. Work sono pursuant t°this permit must comply with <br /> eurrsnt faders/,s(ats,and local law. The this <br /> of a permit only authorizes approved work ane'no devlat♦ona therefrom.bfrom the <br /> a <br /> Building Otflclat Before bratng authodzed under any cifcurrutance./am the owner,or i am authorized beviations must irrsf be authoriz6d In writing fro is made,the owner of <br /> and t comply with the State Contractors Law 18.27 RCW and 290.2ooA WA , /hr's property to perform the worth for which eppJlc <br /> City of Everett Offlcier use Only <br /> PERMIT# <br /> OwnerJAuthorMad Agent Signaturre <br /> Data (Revised 912312016) <br />