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f 3200 CEDAR STREET,EVERETT,WA 88201 <br /> (P)425-257-88 FAX 425-257-8857 j(E)everetteps@everethv 1 www.everettwa.gov/permits <br /> ���an�.•a�u'[�6��i�'llnvl�®__ealjp G�?O��i�i�) - — ' -- •' ... <br /> ' PROPERTY TAX#: <br /> 'RO IECT SITE ADDRESS: I r? r �� / Lot No. (attach copy of long legal description) <br /> EGAL for new construction: Short Plat/subdivision -- <br /> QN't®GAE�1pTg(�6�1 <br /> ::•: J: � TEf DANT NAME(If Commercial): <br /> DINNER NAME: G- � <br /> DWNER MAILING ADDRESS: STREET ZIP <br /> STATE <br /> CITY <br /> 1 p 2� OWNER EMAIL: - <br /> DWNER PHONE '! <br /> ;ONTRACTOR NAME: U7�=( lZ! _ A6 <br /> 3ONTRACTOR ADDRESS: STREET - t ZO <br /> STATE ZIP <br /> CIN <br /> �0[VTRACTOR PHONE: �1 C2�j 'L`�Z `�j t CONTRACTOR EMAIL: t�L,O �` 4�f�Gc' tl r�r <br /> UIRED _ - <br /> �ONTRACTOR LICENSE#(REQ ): l^vc2t.`3 '�"' <br /> CITY OF EVERETT BUSINESS LICENSE;r(RE4U _ <br /> iRED • <br /> ..•. ..,^w.,.. <br /> 'RIMARY CONTACT:J� CT:4`Q OWNERJ .`CONTRACTOR Q OTHER(Please Specify) <br /> CONTACT PHONE: <br /> CONTACT NAME; <br /> CONTACT EMAIL: '�/��per/ •�,,'SjYIGLI��•G�2�`i� <br /> ;.BUILDING.PERMbA'XC®• <br /> Contract Price of Work: <br /> x[sting Use of Building: <br /> Heat Source: 4Gas ❑Electric ❑Other <br /> proposed Use of Building: []Commercial []Industrial <br /> 3uilding Type: FR-Detached []SFR-Attached [] ❑SiDuplex ❑Multi-F gn ❑Sprinkler QDemolition ❑Change of Use <br /> #of Units: <br /> Type of Project: []New L7Addifion []Remodel [�epair QT.I. <br /> )ESCRIPTION Ot-WORK: <br /> ASSOCIATED BUILDING PERMITI, (if applicable): <br /> IVlFv�II�.MICAL: )�t�d�l�"I`AOIP.Ic��1<�tt! ,. <br /> 1�,I�UtIt�lr<\[G fi4TMOA".; PE�� A'E'I®fi't <br /> Type of Project: _•New _Addn Alteration _Repair <br /> ,ypeofProject: _New Addn __ Alteration _Repair hof #of LisfofFixtures <br /> #of #°f List of Flxfures List of Fixtures Fixtures <br /> List of Fixtures Fixtures Fixtures <br /> Fixtures Toilet Backflow Preventer(Inside Bldg <br /> AIC—Air Handling Units Heat Pump Urinal <br /> Unit Neater Bathtub <br /> Forced Air Systems Lavatory(Wash Basin) Drinking Fountain <br /> Gas Piping Boiler Floor Drain <br /> Refrigeration Shower <br /> Water Heater Kitchen Sink&Disposal Grease Trap <br /> Gas Fireplace Wood Stove Roof Drains <br /> Ducting Dishwasher <br /> Gas Range Clothes Washer IUTedical Gas <br /> Clothes Dryer Hookups Other: Other: <br /> Water Heater <br /> Range Hood Sink(Service/Bar/Mop/etc.) Other: <br /> Exhaust Fan <br /> --'�''�•:: �.)�b�111�9>�L��-,/.��PP�I���a®.GOI:�����.�tti.,. . <br /> Number of Heads and <br /> . Work <br /> ursuant to <br /> Is permit <br /> compfy with <br /> ein is true <br /> iCKN <br /> OWLEOGENENT_•1 have reviewed this application and confirm the es approved <br /> work and noned rdev deviations therefrom.Deviations m rst first he authorized in writing ror the <br /> urrenf federal,stale,and local law. The granting of a permit only authorizes appy <br /> luildfng Official before being authorized under any circumstance.I am the owner,orl am authorized by the o�iner of this property to perform the work for which application is ma <br /> nd 1 comply with the state Contractors Law 1 a 27 RCW and 296.200A WAC_ City of Everett Official Use Only <br /> J PERMIT# <br /> ,..,.,...rn„rfi nri7Fd Aaent Signature <br /> v Date (Revised 5/20/2096) <br />