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' BUILDIN��::IIECHANICAL / PLUMBING / SIGN : �'^RINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVIC
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> '�`�25-257-8810 J FAX 425-257-8857 � (E)everetteps@everettwa.gov� wwuv.everettwa.govlpermits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: Z�'J' ��5� /�'fs�/t-�,.i E v��� � PROPERTY TAX#:Z Q OCJ
<br /> E.FrAL for new constructior,� Short P!at�subdivisicr Lot No. (a�ach copy of long lagal descriptia�)�"`
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,�� G�i.�/ ��cJ�'� TENANT NAME(If Commercial): v ,«YT C�J /N'fCE�+/N
<br /> OWNER MAILING ADDRESS: srREEr �Q G /�g
<br /> CIiY �� � I��Cy STATE (/V/_" i�P ��F..��
<br /> OWNER PHONE: '� - 3�j'�- �33 S OWNER EMAIL:
<br /> CONTRACTOR NAME: Qw,�,1��
<br /> C�NTRACT4R ADDRFSS: sTReeT 5 �?n'"��
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<br /> CITY STATE Z�P
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PR(MARY CONTACT: ❑ OW�ER ❑ CONTRACTOR �OTHER(Please Soecify)_.____ ___ __ _ __ �
<br /> CONTACT NAME: CONTACT PHONE: !7/Z� _ Z„��1 _ "��Q�
<br /> G� �' O t/`-T CONTACT EMAIL:�„/�Ej��� ��,y,a,t b.rtryo«.�/�.�i✓c.lt./. Gs
<br /> ��l���l�!(� P�43!ttll�l�PP�.`r�Tl�l�!
<br /> Existing Use of Buiiding: i Ne�%•3-��-. Contract Price of Work: Z 3'� 7 •G Q
<br /> Proposed Use of Building: .t. �l�es f.�..�� Heat Source: �Uas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family-#of Units: ❑Commercial �ustrial
<br /> Type of Project: ❑NeLv ❑Addition ❑Remodel Ctl�R�pair ❑T.I. ❑Sian ❑Sorinkler ❑Demolition ❑Chanae of Use
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<br /> ASSOCIATED BUILDfNG PERMIT#(if applicable):
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<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixtuies #of List of Fixtures #of Lisf of Fixtures #of List of Fixfures
<br /> Fixtures Fixtures Fixfures Fixtures {
<br /> AIC-Air Handlina t lnits Heat Pumn ToilPt �Bar.kflow Preventer i Ins;;.�. 51rr.'; �
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<br /> �!-en�ed Hir 5yster.�s ; �Un�i Heater ; ! ;�3rrttlb � �Ufif131 f
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<br /> Water Heater Refrigeration Shower _ �Floor Drain__ _ _�
<br /> Gas Fireplace Wood Stove VCiicher,Sink&D�s �; ' •". _ -,- �
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<br /> ,Gas Ranae , Ductina .Dis!?wa�"er e i-�� ;Cr�f•�� '
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<br /> HCK�VO6VL'cOC-EMEN i:i have revieweiJ this aoolicallon 2nd confirrn the informatinn containea herein i;(rue and conact. !�l/ork done Uursuant to ihis nerniif must r.omr�l�i wiih
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