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, ��Rnnrr e����.�c.�-roo� <br /> 1 - �U11.D91� i1lIEC9-1,4il16C,��./�'LUIi��1�9G I S9GN�� ��9PIKL�1�I DEMOL.IT60M <br /> CITY OF EVERETT PERMiT SERVICES <br /> • 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everet#eps@evereftwa.gov� www.everetiwa.govlpermits <br /> (�9a�e oa�1�6���s��a&��ua9g�6�➢��se) �����G'�°�9'�°� ift���lt��Pd�i�'p�IR� <br /> PROJ�CT S1TE ADDRESS: ��I� [ � '�'�' �•�„�''�S PROPEIZTY TAX#: �`�d�S}J�J`��f O:� ���3 <br /> LEGAL.for new construction: Short Plat/subdivision Lof No. (attach copy of long(egal description) <br /> COId`i't�AC�'9N��9�ti�i�'�'gOi� <br /> OWMER NAME: ��� (�g�7�� �(:� �1 d$-� , TENANT iVAiV1E pf Commercial): <br /> OWNER MAILING A�DRESS: srReEr �'y �q �'� <br /> CfIY �v��(�, '� STATE 1/V'+� ZIp � G S.l, <br /> OWNER PHONE: OWNEi�EMAIL: <br /> CONTRACTOR NAME; �' '.�� <br /> CON�'RACTOR ADDRESS; srReEr <br /> cirr STATE ziP <br /> CONTRACTOR PHONE: CONTRACTOR EMA(L: <br /> CONi'RACTOR LICENSE#(REQUIRED): C1TY OF EVERE77 BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Z j'— Z�`"� -. � � �'�� p�i�, <br /> �-=�'-rJ� �, L�"��-►� CONTACT EiV(AIL: ,�'(�1�-�i , ►''\ � .C�,d� , C� <br /> BUILDING PERMi7"'APPi.IC�I'I°IOtd <br /> Existing Use of Building: }-rv��e-�' '�'S Contract Price of Work:$ 0 ��6�. f <br /> Proposed Use of Building: Sf�-sv�E Heat Source: ❑Gas ❑Elecfric ❑Other <br /> Suilding Type: ❑SFR-Qefached ❑SFR Atfached ❑Duplex Mulfi-Family-#of Unifs:� ❑Commercial ❑Industrial <br /> Type of Project: ❑New CiAddition ❑Remodei ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolifion ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �� - ..,, �� i � �y �- <br /> � n� � <br /> ASSOCIA7ED BUILDING PERMIT#(if applicable): �n� '�'j�'" ��D <br /> MECI�JI4�RIICAL PEEtM17'APPLCC.P,`I°101�l PIl�dlMBM�+1�s' PERMI7'.f�PPLICATION <br /> Type of Project: _,New Addn Alteration _Repair Type of Project: _New Addn _Alterafion _Repair <br /> #of List of Fixfures #of List of Fixtures #°f List of Fixfures #of Lisf of Fixtures <br /> Fixtures Fixfures Frxfures Fixtures <br /> A/C—Air Handling Unifs Heat Pump Toilet Backflow Preventer(Inside 61dg} <br /> Forced Air Sysfems Unit Heafer � Bafhfub Urinal <br /> Gas Piping Boiter � Lavatory(Wash Basin) Drinking Founfain <br /> Water Heafer Refrigeration Shower Fioor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> �{ Clofhes Dryer Hookups Other. Clofhes Washer Medicaf Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/efc.) Otf�er: <br /> �1P1�6�9�L��'2/S�@�P��SS���S'YSi'EM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•i have reviewed fhis application and confirm the information contained herein is true antl correct.Work done pursuanf to this permif must comply with <br /> current federal,sfate,and local law.The granfing of a permif only aufhorizes approved work and no deviatiorrs therefrom.Deviations must first be aufhorized in writing fr.om the <br /> Building Official before being aufhorized underany circumstance.1 am the owner,orl am authorized by fhe owner of this properfy to perform fhe work for which application is made, <br /> and/comply wifh the State Coniractors Law 18.27 RCW and 296.200A WAC. <br /> � City of Evereff O�cial Use Only <br /> � � �_. �-- PERMIT# <br /> .s�� ��" � �' f �D(v-ppGj <br /> Owner/Authorized Agent Signature Dafe (Revised 9/23/2016J <br /> � <br />