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�[�V��dB�"�I�(��9CA�9��� <br /> ��u�dH� i�������c�,�.� ��.���a��������������i ���o����o� <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ---` (P)42b-257-8810 � FAX 425-257-8857 �(E)everetteps@evereftwa.gov� www.everetfwa.govJpermits <br /> Q��a����C�9��1�Du�l��e�9�/Pt����� P��d�C�'i��0 u� 6�G���6i�/�`�'��� <br /> PROJECT SITE ADDRESS: � �L.L/d"'j'J-_ PROPERTY TAX#: �3 ' � '� � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ��Pe95('��t�t'H�T��[�BIfBe�'T9�� <br /> OWI�ER f�AME: 9 Tj TEi�ANT iVAfVIE(If Commercia!): <br /> OWNER NIAILING ADDRESS: s-rReEr G �'�.�ra <br /> CITY.. � STATE ��,/�J J"'i"' ZIP ��.� <br /> OWIVER PHONE: �j— �- OWIVER EMAIL: <br /> CONTRACTOR IVAME; �--�(.`TE L' ►'VL „o�J t}— y� <br /> CONTRACTOR ADDRESS: s-rReEr T <br /> CITY �I STATE ZIP ��3 <br /> CONTRACTOR FHOiVE: Gf 2 -7 �f CONTRACTOR EMAIL: �j� d��T�. <br /> CONTRACTOR LICEPilSE#(REQU(RED):D,/�'�N C(C.yL� C1TY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q��� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT[VAME: CONTACT PHONE: Z����� <br /> �- ��� CONTACT EMAIL• �j Q ��. � <br /> �u��.o0�� ���nnar���������o� <br /> isting Use of Building: Contract Price of Work:$ <br /> roposed Use ofi Building: � Heat Source: u�as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached t�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: ���JLF�-� �jCl�'jy✓l��/�. 'CS�Tjc J�(t�;l��L+�" (.�1��'} � /J-Q� �}' -$. <br /> �'i,C,2.n�AC��iJ 'TW"�..�.. sH7►'1.�--L�f7�oJ� litl`J �/`e�W �9�-s PI I�Pr�9CA-• <br /> U <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IWEGHAIoI�CAL PE0aM1`9'APP9.ICATIOQ� ��,UM�S9VG l��AtMIT APP�I��,T90Qd <br /> Type of Projecf: _New Addn �Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #�f List of Fixtures #of List of Fixtures <br /> Fixfures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backfiow Preventer(Inside Bidg) <br /> Forced Air Systems Unif Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Firepface 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 Wafer Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �I�R91����R/S1J��R�S�G�� S'YS`�'�1V! <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�l have reviewed this application and confrrm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> �rrenf federal,sfate,and local law.The granfing of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in wrifing from the <br /> uilding O�cia1 before being authorized under any circumstance.I am the owner,or l am authorized by fhe owner of this properfy to perform fhe work for which application is made, <br /> �d 1 comply with the State Contractors Law 18.27 RCW and 296.200A W.4C. <br /> City of Evereft O�cial Use Only <br /> I �� / PERMIT� ���^� <br /> � flll 1 <br /> Owner/ uthori d Agent Signature ate {Revised 9/23/2096) <br />