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May 15 2017 01:02PM HP Fax page 1
<br /> PERMfiT APPLICATION
<br /> BlJ1LDING/MECHANICAL/ PLUMBING J SIGN 1 SRRlNKLER/DEMOLITIdN
<br /> CITY OF EVERETT PERMIT SERVICEB
<br /> 3200 CEDAFt STREET,EVERETT,WA 98207
<br /> tP)425-267-8810 � FA%425-257-5857 �(E)everetteps�ev�rettwa.gov� wvwv.@v@t6liw�.gdvJpermits
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<br /> PR4JECT SITE ADDRESS: �� ����� s �JQtQ: �N� PROPER7Y'fAX�F: !�� �7 I��Qf�O oZ��Q�'J
<br /> LEGAL for rzew oonstn�etion: Short Plat/subdlvtairn����f r��et`�°.S (��L A'f�0" No. �� �atWch copy of iong tegal description)
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<br /> QWN�R IVAME: e����,�(��. � ��� ��{�$��?�"" TENANT NAME If Cornmercial):
<br /> OWNER NlAILING ADDRESS: STREET D � ��'G� S�
<br /> ��n Ey�P e� � STA,� � Z� �1' �a3
<br /> OWNER PHpNE: OWNER EMAIL:
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<br /> CONTRACT�R NAME: � O V� i�'1 '
<br /> CONTRACTORADDRESS: sraeer e''��5� n G�r r
<br /> arr t��t v1� 'i�Q�`�►c3 f\ srnr_ b1.d' zia ��✓�
<br /> CONTRACTOR PHONE: -- �IU� 6 � CONTRACTOR EMAIL: q�rjp U V t�r)���t � ft1
<br /> CONTRACTOR LICENSE#(REQUIRED}; �}{��d�,P " ���. D CI7Y OF EVERETT 6USiNE53 LICENSE#(REQUI ED): �
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<br /> PRIIlIARY CONTACT: CI OWNER �CONTRACTOR ❑oTHER(Please Specify)
<br /> CONTAGT NAME: CONTACT PHONE: '� �._ �� ,..� l�
<br /> �.4�Q`M l� ��1�.(" CONTACT EMAlL: q�SPI V i� �V Y'')b;yl � ��- � �ft Fldt?.CO
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<br /> Existin Use of Buildin : ;n�'j��2, �aM:� L��I <ri Contracl Price of Wvrk:$ 0 fI�O,
<br /> Pro osedUseofBuildin : ���?y( Q � � �.+� ( '/t HeatSource: ❑Gas �Electric ❑Other
<br /> Buildin T e: ' SFR-Deiached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: �Commercia! Dlndustrial
<br /> T e of Pro ect: ❑New DAdditfon emodel ❑Re ir ❑T.t, ❑S' n ❑S rinkler �Demalition ❑Chan e of Use
<br /> DESCRIPTION OF 1A►aRK: ` ` ^ ��� r Q`�,�� i+ �'`��V��
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<br /> ASSOCIATED BUILOING PERMIT# if a ifcable;
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<br /> Type of Project: _New_ Addn _Altera#Ion _Repalr Type of Project: �New TAddn Iteration ,Repair
<br /> #of v�of tixtures #of us!of Fixtures #of �,/st of Fixtures #of Llst af Flxtures
<br /> Flxtures Flxtures Fixtures Fixtu�es
<br /> A/C-Air Handlin Units Heat Pump Toilet Backfiow Preventer Inside Bld )
<br /> �oresd Air S sfems Unit Heater Bathtub Urinal
<br /> Gas Pipin Boile� Lavato Wash Basin Drinkin Fountain
<br /> Water Heater Refr€ eration Shower Floor Drdin
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra
<br /> Gas Ran e Duc#in Dishwasher Roof Drains
<br /> Ciothes D r Hooku s Other. Clothes Washer MediCal Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exha�st Fan Sink Service/BarlMo etc. Other:
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<br /> Chemical or Water No. of Heads
<br /> ACKNOWLEDGEMENT.•/have reviewed thls epplication and conBrm the inlormadon confalned hergin is true and correct.Work done pursuant to thls permif must c�omp/y wJth
<br /> currenf federal,stata,and loca!law. The grant;nq of a permit onty authorizes approved work and no tlevlatlons therefrom.Deviat/ons must f'Mst be authorizad In rwKinq from the
<br /> Buildirrq Ofhcial betore being authorfzed under any circumstance.I am the owrrer,or I am auffio�ized by the owner of tHis properry to perform the work fa whlch appUcadon is made,
<br /> and I comply with fhe State Conbacfors Law 18.27 RCW and 196.200A WqC.
<br /> Gty of Eve►e8 OHlcial Use Only
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<br /> Owner/Authoriz�e Agetrt Signature p�
<br /> (Revis d9/23�20i6)
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