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PERAAIT Ai�RLICAT101V <br /> BUILDiNG / MECHANICAL 1 ��UlU��lIVG / SlGN / SPRINKLER/ D�MC)LIT��i� <br /> CITY OF EVCF2tTT P�RMIT SERVlCES <br /> 320C GEDAR STREET,EVERETT,WA 98201 <br /> (f')425-25i-�810 � FAX.425-'L5"1-c3857 �(E)everei'teps`vcver'ettwa.gov I •�v�vw.everett��a.gov;perrr�it;> <br /> �{�a�� ss. BIaCk ��a� ��a8� �'@e��e`p ������'�':��"�� 36�a=����8'i�i�" <br /> ��a`3J�CT SlT�ADD6`tESS: 1�i�1 �-41:� LL irl.r 1�1(,� I� .��PR�J�EE2TY Tt�X#: <br /> �L�GAL for new construction: 5hort PlaUsubdivisiun__ Lot f�lo. (attach copy of long leyal desa iption? <br /> C�i�lT�C'�` NN�Q��t$'7'�8��'d .�" <br /> O�w�1ER NAM�E: J•i�t;`; ` ;� � l,._ TENANT NAM�.(If Commercial): �� <br /> t7tRlNERUlAILINGADDRESS: sn�eET I�(7�j NU^�.lt'�l-J D�\C.� t�L <br /> cirv �V'E`Z�TT sr�re �,'�.°''a ci� �']�c�G,�, <br /> CiWlJ�R PFlQNE: �'I�5 ` �C��'j — �1 Iv 5' S'S OWNER EMAiL: �C.CLI I L ' >I�V�C G �+• V`cL-� <br /> �t�NTi2ACTOR NAME: XI(�,f� }"�V Q1 <br /> CrJNTRACTOR/�DDRESS: srriEEr ��.���;� �j�p��•v,}���� �i t �U 1 <br /> cirv ��:'L�E-TT � sraTe L,,VA' zi� ���'�G ' � <br /> G�hITt�G70i2 PFiONIE: 4-�S — S l.� —� lD�S`� CON7R�4CTOE2 Efd1AIL: I�c'iY'CUvl �-' L�"��G��✓l Yl iN. � "��— <br /> COlVTFtACTOF�LIGENSE#(REQUIRED): �rXl(y��n t�i Y,G �.�vWi �i.fTY C3F EVERETT HUSINESS LJCENSE#(REC2UIi�ED1 ' � <br /> P3?I�iARY GONTACT: �]OWNER ❑ CGtJ7RACTOR f�UT�HER(Please Soecify)���'t�r-��L ,N1}'��v�(;,ti£� � <br /> CS3(VTAC7 NAME: GONTACT P�iflNE: r-I.�-� -- f�7`� — �,.�-r�-� � <br /> �A'�'� ����n �T l-� �--- (' � <br /> ^OP37ACT�Pa��,ti: l�c.ti('C�r1 �`'�,C'-v�a�e`Vl y��. C i �� <br /> �U�t.E�lE+�C� �'�RMlii'6����.CC�►3"lOd�1 <br /> Exisiing Use of Building: Contract Price of Work: $� � c' �, �, f�� ; <br /> Proposed Use of Building: Heat Source: ❑Gas _lectric G�Jiher <br /> 5uiidirg Type: SFR-Detached ❑SFR-Attached ❑Duplex QMulti-Family-�of Units: C1Commercj�ii� �Industri�l <br /> Type of i�roject: ❑PJevi �1dc�ition ❑Remodel �Repair C1T.1. ❑Sign ❑Sprinkler ❑D�u�olition L}Charjge�f Use <br /> C?ESCRIPTION nF WORK: --� <br /> � ' ''� l +��.1. l�l.)C'l l Y `�5 l\�!\Z \�' av'�� v'=l 7 �-\ � � !�;\�C C` i�` � \% '���� <br /> �S5�3i�3A71Ei�BUILDiNG PERd�A9T#{i%�i��lic<�Ule): <br /> ���a���a���. ���nnMr w������a�acsw� �4�nn��€�� ������a���,�+c�ro�a� <br /> Type of Project: _New _ Adcn .___Alt�>�ation __Rcpair Type of Projt�ct: _Ne�v _Ac�dn Alterat�.�n ___Repair <br /> Fixtur s List of Fix#ures Fixtures List of Fiztures ��f a ist of hixtures #°� � List of Fixtures <br /> Fixturas Fixtures <br /> A/C—Air Handlin Units i�eat�ump Tc,iiLt S�ckflow Preven:�r;lr;side�31rJgj <br /> Fr�rceci Air Systems Unit f-leat�r Bath#ub Urinai <br /> ��as PiGin. Eoiler Lavator Wash L�asin Dririkiiiy 4=ount�ain � <br /> VVater Hea±er Refriqeration SI-rower r=ioor Drain <br /> Gas Firep!ace Wood Siove Kitchen Sink&Dis osai Grease Trap <br /> Gas Range j Duciinr� Disi-��r✓asrier Roof drairs <br /> Clothes Dryer Hookups Other. ClotPies Washer Niedical Gas � <br /> Ran e Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mopretc.) Q4her: <br /> �PF8INKE,E6�/Sll�PRE3�1Ci4�! SY,TEB� <br /> Chen��ical or Water No. oF i-feads <br /> ACKN�WLEDGEMENT:l nave revi�wed this ap;?hc�r�on�nd con!irm tha inform�fron contained her�in is true and c�i�rect Worl<dorre pur�uant to tni;per+nit must cump�';��,vith <br /> current f�doral,sfatr,and local law. 1he yrenip�y af a pernNt only authorizes a�pj��oved wc�k and no deviations ther�frorn.DevroGons rrx�st/irs(be authorized in wri6n�fro,n tha <br /> t3uildrny Ufficiel bef�re beir�q authonzed undEr ar;y circumstance.I srrr the owner,or 1 ar��auihorized Gy the owr�er o(�his properfV to�er(ontt the�n-ork for whtch�pplicahai is rn.�de. <br /> and 1 comply wrth the State ConL�r,tors Law 1 tt.27 RCW and 196.ZOOA WAC. <br /> Cify of Evereit Officia!Use Only <br /> / PERMIT# <br /> `7/7 r � ��� - � l l <br /> O�vne uthorized/�gent Signature Date (Revised 9/23/20�6j <br />