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�����Bi��� �f���1�6�IC�.�.�1 f������� /�S C�h�1�R06���.�6�1�G6l�O�.�T�DOI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> - (P)425-257-8810 � FAX 425-257-8857 �(E)everetfeps@everettwa.gov� wv,nnr.everettwa.gov/permits <br /> Q�Baa��rr�9���5�unl���a@�Pt��s�� I���d��`�'�B4'� 6�6���Gi�l��'B�� <br /> - ROJECT SITE ADQRESS: �{ �p ►'� 0" L. �-j PROPERTY TAX#: <br /> L.EGAL for new construction: Short Platlsubdivision Lot No. (attach copy ot long legal description) <br /> 1��6�5����' �N��fI�BUY�`���� <br /> WNER NAIVIE: (°� TENAIVT idAME(If Commercial): <br /> OWNER MAlL1PVG ADDRESS: s-rRee-r �- <br /> CITY " STATE � ZIP � <br /> OWNER PHO�lE: OWIVER EMAIL: <br /> ONTRACTOR IVAME; 7 �}G ��S y�.. � t '[� - <br /> COIVTRACTOR ADDRESS: sTReEr Q O (�-B 'V <br /> C�7'y ` �,��.�Q_,ej STATE �� ZIP G <br /> CONTRACTOftPNONE: �2 o�y�r3 COIVTRACTOREMAIL: � ,f luvr�t�l� �� <br /> CONTRACTOR LICEfVSE#(REQUIRED): Z � ' C1TY OF EVERETT BUSINESS LICENSE#(REQUIRED)t�t'+,�l <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME: COiVTACT PHONE: Cr2 G <br /> CONTACT EMAIL; <br /> �611�D1@�G �ERIVIA'�"APP�l�A`1'90� <br /> Existing Use of Buiiding: Contract Price of Work: "�P C— <br /> Proposed Use ofi Building: � Heat Source: ❑Gas �Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industriai <br /> Type of Project: ❑New �Addition ❑Remodei ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �U�bt�� �`�,(�,. <br /> '� � <br /> ASSOCIATED BUILDiNG PERMIT#{if applicable): <br /> PVIEC�1AlY1CAl, P�itNFl�'�PPL,ICd4Tl0�1 LIYM�llIdG P�RMIT APPL�9��,T90Fd <br /> Type of Projecf: _New Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #°{ List of Fixtures #of List of Fixfures <br /> Frxtures Fixtures Fixfures Fixfures <br /> A/C—Air Handling Units Heat Pump `2 Toilet Backflow Preventer(lnside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refirigeration Shower Floor Drain <br /> Gas Fireplace Wood 5tove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clofhes Dryer Hookups Other: f Clothes Washer Medical Gas <br /> Range Hood Wafer Heater Other: <br /> Exhaust Fan Sink(Service/BadMop/etc.) Other: <br /> �1��9�9K���!�4J����S�9�E� S�S�'�9U1 <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and locallaw.The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must first be authorized rn writing from the <br /> Building Official Before being authorized under any circumstance.I am the owner,or I am aufhorized by the owner of fhis properly to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Evereft Official Use Only <br /> PERMIT � 1 O ���� <br /> � ��� l� � t <br /> Owner/Auffiorized Agent S�gnature D e (Revised 9/23/2096) <br />