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PERiV11T�4PPLICP►T101`
<br /> BUILDINU �lIECHANICAL/PLUMBING /SIGN ��INKI�ER/ DEMOLITION
<br /> CITY OF EVEREfT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-$810 � FAX A25-257-8857 �(E)everetteps@everettwa.gov� www.everetiwa.govlpermifs
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<br /> pi20JECTSITEADDRESS: �N�.� ����„tp(,. ��/�` PRO�T ��
<br /> LEGAL for new construction: Short Plat/subdi�ision Lof No. (attach copy of long legal description)
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<br /> OWN�R NAME: �,G�.�"�p" �NV�S�^�S �lr G TENANT NAME(If Commercial):
<br /> OWNER MAILWG ADDRESS: S7REET �� 130 X ZZ2
<br /> CffY �./4L�•t STATE �/h ZIP � ��
<br /> OWNER PHONE: Z S 3 . �Z�• �1�V OWNER EMA1L: , ,
<br /> CONTRACTOR`NAME:� �/Afl.l�I/�'v ,n/�'�S'�^ �'�'� �
<br /> CONTRACTQRADDRESS: eEr 1`I1� l� S S
<br /> crrv 'C R STATE u/4 � ziP R(�H�I N
<br /> CONTRACTOR PHONE:'i�S3. 3'Z • d(� CONTRAC EMA (Y v�K,91^�V i N vCS'`I'�1� � G'"��L•��
<br /> CONTRACTOR LICENSE#(RE ED): CC� VA/'L���. Sh YCI. C1TY OF EVERE USINESS LIGENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER �1 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NA CONTACT PHONE:
<br /> STEPN�. M � T1�' CONTACTEMAIL:
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<br /> Exisfing Use of Buiiding: Contract Price of Work:$ �m0
<br /> Proposed Use ofi Building: Heat Source: C7Gas OElectric l�Other
<br /> Building Type: SFR-Detached ❑SFR-Attached QDuplex I�Multi-Family-#of Units: ClCommercial ❑Industrial
<br /> Type of Project: I�New ClAddition I�Remodel �1Repair [�T.L ClSign �lSprinkler �IAemalition ClChange of Use
<br /> DESCRIPTION OF WORK: ML� �,�„�G�
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Pro�ect: _New_ Addn _Alteration �Repair Type of Project. _,New �Addn _Alteration _,Repair
<br /> #of #of List of FixtuXes #of List of Fixfures
<br /> Fixfures List of Fixtures #�f List of Fixtures Fixtures
<br /> Fixtures �ixfures
<br /> A/C—Air Handling Units Heat Pump Toilet Backflow Prevenfer(Inside Bldg}
<br /> Forced Air Systems Unifi Heater Bafhtub � Urinal
<br /> Gas Piping Boiler Lavafory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration 8hower Floor Drain.
<br /> Gas Fireplace Wood Stove Ki#chen Sink&Disposal Grease 7rap
<br /> Gas Range
<br /> 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:
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<br /> ACKNOWLEDGEMENT.•I have r ed this application and confrrm the Information contained herein is true and correct.Work done pursuanf to this permit must comply w/th
<br /> current federal,state,and loc .The granting of a permit only authorizes approved work and no deviations therefrom.Devlations must first be aufhorized in writing from the
<br /> Building Officia!b fore be'g horiz under any circumsfance.1 am the owner,or!am authorized by fhe owner of this property fo perform the work for which application is made,
<br /> and 1 ply w' the ate on rs Law 18.27 RCW and 296.ZOOA WAC. Cify of Everett O�cial Use Only
<br /> PERMIT#
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<br /> Own / orized Agent Signature D e (Revised 10/12/2095) '!� ';
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