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�f�G�d�4dQ��' e�����.@�A�9�6' <br /> f��9d��6f�� I ���PrB��llC�a�I ���➢f�f��9d�l�, I��(s�l9 /�G�'��G�G'a�.�6�/ �I�(�f���_.9�9�It� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/perrnits <br /> Q�a�� �� ��a�� ao����o� p������ ������� �o�r� ar�������a�� <br /> PROJECT SfTE ADDRESS: °'4� ��� � �0 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ���.9�'C�1�'1�' BI���II�IIl��`�'��9� <br /> OWNER NAl1�E: TEIVANT PJAME(If Commercial): <br /> OWNER IIAAILING ADDRESS: sTREEr '^1`-'J� <br /> CITY v � SIATE ZIP�� <br /> OWNER PHONE: �'-� — � '�I� OWNER EMAIL Y <br /> CONTRACTOR NAME; �j � � <br /> CONTRACTOR ADDRESS: sTREEr � '� <br /> c <br /> aTv '(�WG(� sraTE ziP <br /> CONTRACTOR PHONE: �" ��T Q"1�U� CONTRACTOR EMAIL: �� <br /> CONTRACTOR LICEP�JSE#(REQUIRED): �� r"��� I I CITY OF EVERETT BUSINESS LIC SE#(REQUIRED): <br /> PRIMARY COh1TACT: ❑ OWNER L�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �j(p� K COIVTACT PHONE: �,.,� l.�`�l� � � � .. y <br /> �X� � CONTACT EMAIL: v. I "I <br /> . <br /> �uA��s�� ���n�aa�a���Ac�e�ao� <br /> Existing Use of Building: � Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � ��v`�CQ� �,�(`(�� (���'Y� Y►(M� C�,1 �L�➢�an <br /> �'C' �'� � YVts.,J �,c�G�►�o'� i r� � �,�� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IV�ECFIAYVO�A4. PERMI"9'.4PPLICATIOQd �L.l1M�ING PERMIT APP�9�ATDO�d <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Aiteration �Repair <br /> #of Lisf of Fi�cfures #�f List of Fixtures #�f Lisf of Fixtures #�f Lisf of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> ��Q2oBdKL�R/ $1D��12ESSA�9d S°!S'f�iVi <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 fo this permit must comply wifh <br /> current federal,sfate,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifing from fhe <br /> Building Official before being aufhorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform tlie worl<for which application is made, <br /> and I comply�h the State Cohtractors Law 98.27 RCW and 296.200A WAC. <br /> � City of Everett Official Use Only <br /> � PERMIT# <br /> ' � � � �� � � � � � �� ����� <br /> n �/ orize Agent Signature Dat (Revised 9/23/2016) <br />