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<br /> � ��RMII"APPLI�.A.TaC�9l
<br /> L ' �UIL.DIlii[�/I�i�GH,�.�9��,4L,!PL.t3il��I�(31 SI�t�/SPR6i��CL�Rf�E[�dOLi7'I�Y�
<br /> GI7Y OP EVEREI-i'PERlUI1T SERVICES
<br /> 3200 CEDAR STREET,EVERE7"1',WA 98201
<br /> (P)425-257-8610 j FA3C 425-257-8857 j(E)everetfeps@everetiwa.gov� www everetEwa.gov/permits
<br /> ������u�f�ff�i�l�'lli��CC�avIIjyl�Q,����� � .. ����9I�.���6'���11�IF��1���'T�d��'( � ' ' . � - . • •. •
<br /> . .. . .. ... _ . .... . .. . . • . , . .. . .. . . . . . _.. . . . . .
<br /> FROJECTSiTEADDRESS: ��'�Z--- �� 'i" , c�,)f.(J PROPFRTYSAX�:
<br /> L�GAL for new construcUon; Shorf Plaf/subdivfsion Lot No. (affach�opy of fong legaf description)
<br /> •n.;• •i^ � . • •. ' � � " db�lr,�(�l';�,�,[�'77"�R9�`"�.,�1���'ii`��1�[ • � • .. , .. . .
<br /> OWI��R AIAME• ��4 � t�( TEtVAN7[VAN(�(If Commerciat):
<br /> OWNER M,41LIlVG,ADDRESS: STREE7 'Z����^ ✓LJt►'/ (7
<br /> CftY � STATE � ZIP "G�
<br /> QWN�R PHONE: �j�--- ��Yf OWNER EMAI[,:
<br /> COPITRACTQf2 iVAME; (�=i �� ��
<br /> COt�(TRACTOt�ADDRESS: srReET 2.!zp �-<.t� LC- '
<br /> crrr — sr,a-rE �R ziP �l�2�C
<br /> GOPVTRAC70R PHONE: �f2j� "Z52— �[(r-f' COIVTRACTOR EMAIL: C�Q.G3S(r►''�CVGt�� �G:cJ
<br /> GONTRAG'i'OR LICEfiIS�#(REQUIRED)' �—��(L�y� - • CITY O�EVERETT BUSINESS L[CENSE�(R�QUIE2�D): � ''
<br /> pRiMARY CONTACT: ❑OWNER `�CONTRACTOR C�OTHER(Please Specify) u
<br /> CONTACT NAM�: , CONTAGT PHONE: (�Z� ,j��`�-7 �
<br /> �L�� �L1a GONTAGT EMAIL: '�,�„���.Sf3'�Lfd�..(�i.�
<br /> ,. . _. . . . • ... . , . . . • .. . _ . . . . • .
<br /> ;.�;_ � � � :�suii:u:itiG.��izivtii:�p�i:ic�,�r�o� -
<br /> Fxisting Use of Bui[ding: Confract Price of Work:v�
<br /> " Proposed Use of Building: Heaf Source: Gas ❑Elecfric ❑Other
<br /> Building Type: FR Detached ❑SFR Affached L7Duplex ❑Mulfi-Fami(y-#of Unifs: C[Commercial ❑Indusfrial
<br /> Type of Project: ❑New QAddifion ❑Remodel ❑Repair QT.t. ❑Sign C1Sprink(er CIDemolition ❑Change of Use •
<br /> DESCRIPTION��WORK: � � �� �T���,! �' �j�(,�
<br /> �1
<br /> ASSOC[ATED SUILDING PERM[T#('f applicable):
<br /> . . .. . . . . . . _. •
<br /> ::,.��11IE��if�i�9�.�L::�E�[111N7t''�1��I�ATC0�1' �`' ' ���9�V[�b4lI��P��9'9':���1�4�i�i'd"�OE� '• • .
<br /> Type of Projecf: _,,1Vew_ Addn V,AI#era#fon _,Repair Type of Frojecf: ^New Ac(dn �,Afteration _Repatr
<br /> �of List of.Fixfures ��� Lisf of Fixfrrres ��f .Ltst af Fixfures #°� List of Fixfures
<br /> Fixfures Fixtures Fixfures Fixtures
<br /> A/C-Air Handling Unifs ' Heat Pump Toilef Backtiow Preuenter(Inside Bldg)
<br /> Forced Air Sysfiems Unif Heater Bathfub Urinal
<br /> Gas Piping Boiler Lavafory(INash Basin) Drinking Founfain
<br /> Wafer Heater Re;rigerafion Shower Fioor Drairt -
<br /> - Gas Fireplace Wood Sfove Ktchen Sink&Disposal Greasa Trap :
<br /> Gas Range Duefing Dishwasher Roof Drains
<br /> CIofhes Dryer Hookups Other: � Glothes Washer Medical Gas
<br /> Range Hood Wafer Heafer Ofher:
<br /> Exhaust Fan Sink(ServicelSar/Mop/etc:) Other:
<br /> ,..,�-�,.•..:•....._ . . . ._ :_._...,.... .
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<br /> Number ofi Heads
<br /> ACKNOWLEDGEMENT l have reviewed this applicafion and conflrm the Information confained/�erein is t�us and cor�ecf:Work done pursvant to this permit musE comp/y with
<br /> cur�ent federal,state,andlocal law.The granfing ofa permit only authorizes approved work and no deviafions fherefrom.Deviafions mustflrstbe authorized In w�iting from the
<br /> BuJlding Officia!befo2 being eufhorized under any circumsfance.!am fhe owner,or!am authorized by the owner of this pmperly fo perform fhe work for which epplication fs made,
<br /> and!comply wifh the Stafe Confracfors Law 18.27 RCW and 296 200A VI/AC.
<br /> Clty of Evereff O�cial Use Only
<br /> (� PERMIT _ .
<br /> G��a �- ���- �7 �b
<br /> Owner/Aaffiorized Agent SignaEare Dafe (Revised 5/2012096) .
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