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(P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 0..04ECT S•ATE I NI.P•O 6i IA`f Q.®.- <br /> �9��.'c�r[�9ai�l;��I[uuE�._®irollji pa�0s�} . . . ... . ._ - <br /> :.. .. .. PROPERTY TAX#: <br /> ROJECT SITE ADDRESS: 1 Z) — \,l�L�� i v <br /> E <br /> GAL for new construction: Short Plat/subdivision <br /> Lot No. (attach gopy of long legal description) <br /> WNER NAME: ( v Muiekr2Aii TENANT NAME(If Commercial): <br /> WNER <br /> MAILING ADDRESS: STREET ? ( fit V( 2c) .bzlvt— <br /> r' . -' i STATE �.4 .. ZIP�-(!J <br /> CITY ry(_i <br /> WNER PHONE: ......... ...:..l OWNER EMAIL: .. . . .. : ,. .. T.. .. <br /> ONTRACTOR NAME: N(i7L=t ,4Z �i1,5s'ti . - tc lit <br /> ONTRACTOR ADDRESS: STREET Zt Z.4 R,k-V._±Le-- <br /> ��..— STATE L9;�1 ZIP '1<2o <br /> CITY �E%(�'_:L1 <br /> ONTRACTOR PHONE: H-2.5) 252- ,5(t 4-- ICONTRACTOR EMAIL: i.2-04-0_g--%V-r1(4_,a_:c::vws <br /> • I CITY OF EVERETT BUSINESS LICENSE#(R1;QU[RED): (7/1766-'f <br /> ONTRACTOR LICENSE#(RERUIR_., L-�;c2 Vis_;_ . fi'i`— ,,,w..-,.-_._.--.,: ,._,�.._�.,_ <br /> ONTRA _ _ , <br /> RIMARY CONTACT:�❑ OWNER y CONTRACTOR 0 OTHER(Please Specify) <br /> ONTACT NAME: CONTACT PHONE: (tits-) 5-63, --ef7-Z2.- <br /> ILt:.IJ CONTACT EMAIL: va 1,.,,f2 a SSjYICv •&}-r? <br /> UILDI€N E . - - - <br /> _ ... '.�.. .•G P �RtVi17'�.APk'LI�,f�TICJN ' <br /> Contract Price of Work:$_ <br /> Kisting Use of Building: • <br /> Heat Source: T4Gas ❑Electric ❑Other <br /> ,thrid Use o> FR-D: - <br /> .gilding Type: SFR-Detached ['SFR-Attached ['Duplex ❑Multi-Family�of Units:_ <br /> ❑Commercial ❑lndusfrial <br /> /pe of Project: ['New ❑Addition ❑Remodel Repair ❑I.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> • <br /> ESCRIPTION OF WORK: &i / <br /> SSOCIATED BUILDING PERMIT#(if applicable):____ ___ — --- <br /> 'pe of Project: New Addn _—_Alteration Repair . 1 Type of Project: New Addn Alteration Repair <br /> I#of i#of :#O1 List of Fixtures <br /> Fixtures#f ofList of Fixtures List of Fixtures Fixtures <br /> List of Fixtures Fixtures <br /> fixtures � Toilet Backflow Preventer(Inside Bldg) <br /> NC-Air Handling Units � Heat Pump Urinal <br /> Gas <br /> Unit Heater Bathtub <br /> 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 /> Gas Range Ducting Dishwasher <br /> Other: Clothes Washer Medical Gas <br /> Clothes Dryer Hookups Water Heater Other: <br /> Exhaust <br /> eRanFad I <br /> Fan Sink(Service/Bar/Mop/etc.) Other. <br /> eSPRI J ll=.1E1k/5'0p> 64.t ioEd:dif` tail... <br /> Number of Heads <br /> ith <br /> :KNOWLEDGENiENn•1 have <br /> law.f Thed this granting of atpermit only authorizes approved work and no deviations therefrom.Deviations must first be this <br /> in writing fromcomply the <br /> Tentg Official <br /> state,and local9 <br /> riding Official before being authorized under any circumstance.t am the owner,or!am authorized by the owner of this property to perform the work for which application is made <br /> I/comply with the State ontractors Law 18.27 W and 296.200A WAC. City of Everett Official Use Only <br /> PERMIT n 1,- 0 e �r j, <br /> 1 `� r <br /> `�� �- ����Z <br /> �� ��� � <br /> ..-.,,,.!AItrhnri7ori Aoent Signature Date (Revised 5/20/2016) <br />