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� ����ir����..�c�a,;rro� <br /> �urc.�►��i��c���lc.��.���.������i st���s����v�z���r���o�,r�ro� . <br /> CITYOF EVERETT PERMIT SERVECES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> {P)425-257-881Q � FAX 425-2b7-8857 �(E}evereifeps@everettwa.gov� www.everettwa.gov/permits , <br /> �lue�or�Iack Iti[��n1]'(.�te�jse) � • � �E���l�R,'�'S!`P�1N���MA'�`M�W .. . _ . , , . <br /> PROJECTSiTEADDRESS: �LLa ��'IV��',�"��./�,�� PROPERTYTAX#: � C��-� <br /> LECtiAl.for new constructton: Short Platlsubdivisfon Lot No, (attach copy oF long fegat descriptlon) <br /> . . . . . - ' � .�OPITAC'i'.IN�O�¢It1.�'�'MOR1 • ' • •� • ., . . . . . . <br /> OWiVER NAM�: �j� � �-i({r}�'�1 TEIdANT 1VAM�(If Commerciat): <br /> OWNER MAILING ADDR�SS; srRE�r ��� �C' ��P . <br /> c�rr k%�� srare �;�� vP �2(;)� <br /> OWNER PHONE: `-i',ZS 3�6''I�<� ' OWNER HMAIL: <br /> CONTRACTOFt IJAME: �U�2.��G�.� �✓`�"vk�`"[� ��f��In��c- - <br /> CONTRACTOR ADDRESS: s�rae�r 'ZI� �l� s�(�� <br /> cirr '�V�(2(�j"�" sra� (,1,/.� ziP ��20 <br /> CONTf2ACTOR PHONE; ��.°�S 2.��j(� . CONTRACTOR EMAIL: '{���`�' �' ��SYYI�IC�( + C�,�Y}�} <br /> CONTR.4CTOR LICENSE#(REQUIRED): �(�(�`�(s.�js��,�p CITY OF EVERETT BUSINESS L(CENSE#f(REQUIRED): G] �j' • <br /> PRIMARY CONTACT:M C7 OWNER M I�.CONTRACTOR. CI OTHER(Please Specify)f • <br /> CONTACT NAME: COIVTACT PHONE: !�2�j�'_�s7�»^�j/j!� <br /> i�-��`�"� C-�F' (L� / YI.��..� CONTACT EMA[L: I`�C_"`''ci_�v�Y)Y w't •Ct <br /> . . . . . . .. `. BUILDIN�PERn![!T APH,LICI�TION � � � • � ' � � ' ' �� • <br /> .. F�cisfing Use of Building: � i �l Contract Prtce of Work:$ � <br /> Proposed Use of BuEiding: Heat Source: �Gas DElecfric ❑Other <br /> Building Type;�FR Detached CISFR Aftached DDuplex ❑Multf-Famiiy�of Untts: ClCommerctal ❑Industrtal <br /> Type oF Projecf: 17New L7Additton IIRemodel Repafr i�T.I. ❑Sign L7Sprinkler ClDemolition ❑Change oP Use <br /> DESCl21PTION OF WORK: <br /> ��i��C���. ��i.� �{�{'�Cd�.- <br /> ASSOCIATED SUILI7ING PERMIT#(if a plicable: <br /> ' .kVI��CI�'.�1RI►G.AL PE�tfI1lIT APP�,I�;A,TIORd � • � . P1.I1M�Mttt�P�RtV�,i°,[',�,�L�LIBA,7'1ON : . <br /> Type of Projecf: _New_, Addn Afferafion___,Repair Type of Projecf:,_,htew Addn Alteratton ,_,Repair <br /> �°f Ltsf of Fixfures �°f List of Fixtures �°f Llst of Ffxtures �°� Llst of Fixtrtres <br /> FJxtures Flxfures �lxfures F/xfures <br /> A/G—Air Handling Unifs Heat Pump Toilet Backflow Prevenfer(Inside Bldg) <br /> Forced Afr Sysfems Unit Haafer Bafhfub Urinai <br /> Gas Ptping Bofler lavatory(Wash Bastn) Drinking Founfatn <br /> Wafer Heafer Refr[gerat(on Shower F(oor Drain , <br /> Gas Fire lace Wood Sfove Kitchen Sink&Dts osal Grease 7ra <br /> Gas Range Ducfing Dishwasher Roof Drains <br /> Clofhes Dryer Hookups Ofher: Clothes Washer Medical Gas ' <br /> Range Hood Water Neafer Other: <br /> Exhaust Fan Sink 5erv[ce/Bar/Moplefc.) Ofher: <br /> : .����i[�Y1�4t,�G�%�.171��Rf�S�N��9 SY�g�i�tl <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•l have revlewed th/s appllcatlon and con�rm fhe/nforma(lon conialned hereln is t�ue and correct.lii/ork done pursuant fo thls permif musf comply wlth <br /> currenE federa/,stafe,and loca!law.The granting of a permlt only authodzes approved urork and no devlatlons fheref�om.Devlatlons must flrst be authorized In wrif/ng from fhe <br /> Building O�clal before being author/zed under any clrcumslance,l am the ownel or/am aufhorized by the owner of thls properfy to perfarm the work for whlch appllcatlon Is mada, <br /> and/comply wlth fhe Sfate Confraclors Law 98.27RCW and 29B.200A WAC. <br /> Cliy oPEveretf Off/claf Use only <br /> r PER T I� ��_�� � <br /> �� � ��� 3��I �� <br /> OwnarlAuEhorized Agent Signafur Date (Revlsed 5/2D/�09&) . <br /> � � <br />