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04/19/2016 12:23 FAX 5058161364 Accounting Services �j0001/0001 <br /> 04/19/2016 10:45 FA� 425 267 � EVERETT PEI2MYT SERVZC- �001/OU� <br /> P�RM1T APPLICATI� <br /> BUIi.D1NG/M�CHANIGA�.,/PLUMBiNG/SIG�!/SPRINKLER/ DEMOUTION <br /> CI7Y OF EVER�7T P�RMtT SERVICES <br /> 3200 GEDAR STRE�f,El/EREIT,WA 88201 <br /> (P)425 257-�8810 �•FAX 425-257�8857 �(E)eve[etteps@ever�tlwa.gov� www.ever�'Efwa.gov/permits <br /> y�s � :�r.�:: `� ¢.•.yrs <br /> " - :::: �:r- •"� - ,;: '�- �PR8;1&4T`5'F��.. �F�RINh'1'�ON-�.-..' �_:.: �_= •., <br /> .� =�� - - �.. •� - - <br /> ......,.,.:... .. .�-�.... r....:..... :.. .1._..,,.,......:...:......... ....__._ _._, ._ ._--- - ... . . ..�.. .. . . .� , .. . <br /> PRO,J�CT SITE�bl2E�� S� �v 3 PROPERTY TAX�: b b $C�g L OO� d D l 0 F7 <br /> !` <br /> I.EGA1.for new censtruction: Shart Plafifsubdiv�.sIon Lof No. (atfach capy ef long tegal desctiption) � <br /> :,; .t` - "O._ .`--• "t;' . �•`•:;• - 'a _ •: <br /> :,;' 'c�; - ":��'N�`i'A�1����� �`1" - .= <br /> ���: '�,_Q_.. .N_QR�._�.1lV�`�-�•.; :ti> <br />- oWNER'NAME: �'f�, „C •4 c�-c '� L l 4 i�.. '�ENAN'f T�lAME Qf Commerctal): <br /> O'WI�lER MA1LINt3 ADD}i�5S: s�'r 1�l.� .� S'� s <br /> �� ��� � �A,� ��-- LP �a�:� <br /> owN�R p�o�F: �,/��5-s��- o l�j dWN�R EMAfL: d vrt- e�a�� e !I a k�. l�e�i�a�l�c a w,. <br /> cor�acroR wann�: � -2 � � <br /> CONTRACTORAEIDR�SS; srxe�T <br /> r,iTy S7ATE a►' <br /> CONTRAC'iOR Pt-CONE: ' CONTRACT�R EMAIL• <br /> CON'jRACI OR E,1C��ISE�(REQUlREA): Ct7Y OF E1/ERE3l'BUSINESS f.ICEMSE�{RE4ultiED): <br /> RIMARY COM'ACT: �L�$O�WfVER �17 COMRAG'i'OR' ❑OTHER(Please Speciiy) - - - - - <br /> CONTACT NAl1AE: • CONTACT PHONE: �'.�S-S d�a�D/ � <br /> ;c7� C��l}e�(c�,� ��A���.: �r�_��a�� l��►���c����l C��,. <br /> ` -s: <br /> t=,;��_,_ . . _ . ._.,� . ..�.:.v.�-::: ;<;BUNR:o��is ei��i���r.:i��car�oH�`; - � � � :;:' :,` <br /> � ��..;. �� - <br /> Exfsbng iJse af Bulldmg: Contracf Price aF Work$ <br /> Pcoposed Use of BuiJdn : Heat�So�uce: i7Gas DElecfric E�Other <br /> Buildin • C15�R-Detached ❑SFR Attached ❑D f�c ClMulti-Farnt #of Units: IICommereial ❑IndusUisl <br /> ?' of Pro c� DIVew DAdditlan C1Re►rtodel ❑Re Ir CfT.I. OSi n CiS riNcler ❑D�moli6on ❑Chan of Use <br /> DESCR1PTlON OF WORK: n� _ 9�C� � �dL.'f-� '�[T�'`�-� . , <br /> r,iC_ �l <br /> �l� S1: S�-Uhit �.�� <br /> ASSOCIAT�D 8I3fl�DlAEG PE12NlIT# i�a Iicable}: � ��� �� <br /> k NritV:.!,�C�1N1�Ai: :��I1T;�,PPL:��A�EAI�-". . .a ��s.�. �:'�!LCj,�,B�N�C�i�!E. ��'��'�:'�4,�'['it�N�,:�'.i�t", , r- _ <br /> , . . .. . _. ... ,.. _ .... __ . ...... . _ . ... .. <br /> YPe of Prqject _�lew� Addn ___�41�ratlon �'•epair I�rpe of Prajec� Kew _�4ddn _�,Alteration r,Rspahr <br /> 3�of Lisf of Ftxturas �of LFsf afFn�chmes #of Us!of FDrfi�res �� Ust ofFbcfur�es <br /> FixYures' F"ufures Faftrres F"aturea <br /> A!C—Air Handlin Units Heat P�rn Toitet Bacldlow Praventer lnsfde BI <br /> Forcad Air ams Unit FEeatar BatMub Usinal <br /> Gas Pi in Bo7er Lavafory ash Basin D[�rikirLq FourrEain <br /> / Wafier Heater Refii eration Shower Floor Drain <br /> Gas Firepiaoe Wood Stove lGfchen Sink&Dis osal Grease Tra <br /> C�as Ran e bucti[tg Dishwasher Roof Drains <br /> Clofhes D er Hookups Other. Clothes Washer iUledical Gas <br /> Eta e Hoocf Water Heafisr O�her. <br /> E�aust Fan Si�k ServiceBar/Mop/eta Oti►er. <br /> n.:`:'v�SE�N�.1,$<. Rp�v����.�!}�`��'�lY[;..r::: <br /> Number af Heads <br /> ACKNOV►4.EDGEMENT.1 have review8d�his appficatian and c�n�irm the 6�lnrmaiion coirlaJned harei�is h'ue and correcf. (NorlL done ptusuant fo fhls permif must camply widh <br /> wirnanf ledere;sf�ta,end Iocal/aw.Ths g�nfr�of v parmlt only aufho�ias appravarl wavk and no davlailons lhvrnfmm.Devtatians must fvst be audtomed In wn7k�y frt�un fhe <br /> BuiJdinq ' bedvre being autttwiz�d under arry c}rtxrmsfanca!am fha owner,or/am a�Nrorked by fhe avunerofthis pmper[yto pe✓form 65a work for whlch applTcatian!s made, <br /> and/ plywifh�re Siad9 ConLraicto�s[aw isE27 RCWand 29s 2o0A W.A� <br /> Cily of Everett O�l Use Only <br /> r���o�� PERNtIT#� � <br /> 0 <br /> Owiier/Authorized Agent Signature Date (Revlsed�Q/Y 015) <br />