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PERfif➢Il°'A�PL.ICs41'606v�
<br /> �(J�L.DING I�f1��H�NIC�►L./PLU��[i�l�I SIGN 1�9�RI��LER/DE�t10LIYQO�I
<br /> C1TY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)evereffeps@everetfwa.gov� www.everetfwa.gov/permits ,
<br /> (�lue or�lack I�1�O.nly_�lease) � � �f����t�7`�t`P�II�l���flllA`�I�W .. .. - . , .
<br /> PROJEC7 SITE ADDRESS: � � � — � ST PROPERTY TAX#: oO����V D�!�-I�avO
<br /> L�GAI..for new consfrucfion: Short Plaf/subdivision Lot No. (aftach copy of long fegal description)
<br /> . .. � - - • • . - ' .��NTA�'P.IN�'�IiMA`4'I�N • . , , . . . . . . .
<br /> OWIVER IdAME: �jl' �C � � TEIdANT NAME(1f Commerciai):
<br /> OWNER MAILIfVG ADDRESS: sTReer � "f 1— S lJ�Y 1 S�
<br /> c�Tr �:Q�� STqTE ziP'I ��
<br /> OWNER PHOfdE: � �"(�� I � OWIVER EMAIL:
<br /> .....,,_...<,'.._,......._...... ,_�_T..�.,..,.........,....r. _.�......._._....._.,�.. ....,_....___...,.,..,:_._...............:....,_ ...,...,........_.�......... ..�....,.:..,..,..,.,......._. , _
<br /> CONTRACTORNAME; CUI�Yc.�u�� �TTt��(-� �a$���W1,61^�-
<br /> CONTRACTOR ADDRESS: s-rReer 2I°1� �l� aacU�
<br /> IT( �F:rUrsYC-�� STATE �J.� ZIP (���
<br /> CONTRACTOR PHONE: �°Z�•°��2 P�j/J • CONTRACTOR EMAIL: ��1�..e ��' ,
<br /> CONTRACTOR LICEfVSE#(REQUIRED): �(,{�`�(�.����.�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): l•,��j �j'
<br /> ..,...�...__...... ,., . „ ..� _,.... ., . ,., . .. . .� ,,,. . . ,.. <...� „ � ._ .,,,...,.,..__.._��..,,....._�....._..._...�..---......_..., - - -
<br /> PRIMARY CONTACT: ❑OWNER 1�.CONTRACTOR ❑OTNER(Please Specify}
<br /> CONTACT NAME: CONTACT PHONE: !��g_Z��d���l�
<br /> �1(�C. � ► � �t�1`�' � CONTACT EIVIA(L: �S I..e '�Srn��i ,
<br /> � �� � � � � � � � �� BUIL.DIN(a PERIVi1T APPLICATION � ' . . . , . . � � .
<br /> Existing Use of Building: � � Contract Price of Work:$ g��o
<br /> Proposed Use of Building: Heat Source: Gas ❑Elecfric ❑Other
<br /> Building Type: SFR-Defached ❑SFR-Aftached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Indusfrial
<br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair �T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OP WORK:
<br /> I'��J�a C,� �►'1GQ �(�CG�,-�P -�,tl�hG.G� iY� C i��i t�t)ISpG��. ,
<br /> ASSOC[ATED BUILDING pERMIT#(if applicable):
<br /> ' .M��I�AAtICAL,PERIY[IT APPI.IC:ATIOM � � �L.�lM�IMG PERlllill'APPLICA7'MOM : .
<br /> Type of Projecf: _New_, Addn Alferation _Repair Type of Projecf: _New Addn Alferafion _Repair
<br /> #of �lst of Fixtures #of List of Fixfures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Frxtures Fixtures Fixtures
<br /> A/C–Air Handling Unifs Heat Pump Toilef Backflow Prevenfer(Inside Bldg)
<br /> Forced Air Sysfems Unit Heafer Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Founfain
<br /> Wafer Heafer Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kifchen Sink&Disposal Grease Trap
<br /> Gas FZange Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Ofher: Clothes Washer Medicaf Gas �
<br /> Range Hood Wafer Heafer Other:
<br /> Exhaust Fan Sink(Service/BarlMop/etc.) Ofher:
<br /> . af@��.II�YI�'C��lf�/�iQJ��R���7�Pd �Y�Y��9
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•l have reviewed this application and confirm fhe information confained herein is true and correct. INork done pursuanf to this permit must comply with
<br /> current federal,state,and locallaw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.!am the owner,or I am authorized by the owner of this property to peiform the work for which app/icatron is made,
<br /> and l comply with the Sfafe Contractors Law 98.27 RCW and 296.200A WAC.
<br /> City of Everetf Official Use Only
<br /> PERMIT#
<br /> �,r1 [ -Dl�
<br /> O er/Aufhorized Agenf Signafure Dafe (Revised 5/20/2076)
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