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BUILDIN�ECHANICAL / PLUMBING / SIGN 'RINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVIC
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> �p1425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: �� ��5� /�J,.a�s„�� C/(�c.0 � PROPERTY TAX#:Z a od
<br /> s,F�=e1 for nev�constru�tion: Short Plat!subdivisien Lot No. (a±tach�cnp nf!en�le�al description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,�� G�N ��v� TENANT NAME(If Commercial): v ,c..�f7 �it/ ��J�E�/N
<br /> OWNER MAILING ADDRESS: sTReer �Q � /�S
<br /> CITY `� I /�Ld STATE (,/\,/� ZIP �� ��
<br /> OWNER PHONE: �j— 3�j'r"'j— "'7�'j3 S OWNER EMAIL:
<br /> CONTRACTOR NAME: Qw�_
<br /> G4�T!?4rTC�R AQL�RESS. sTAF=T 5 �G7/y��
<br /> /�
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR �OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: G�Zr� _ Z/O — 7 ZQ�f
<br /> G� �' 4�/t-�' CONTACT EMAIL:�„Jf E�tR,� �l'I,e,s6.rtM�.~n/�,.i✓clb�• Gi
<br /> �lll�DlNta P�RM1T APQ�1���'��R� .�
<br /> Existing Use of Building: i.�—e�•e s �n... a—/ Contract Price of Work: �� �'���
<br /> Proposed Use of Building: / .. e�M 3 ��-r .. � Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type� ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [�'�ustrial
<br /> Tv�e of Proiect: ❑New ❑Addition ❑Remodel �'F�oair ❑T.I. ❑Sian ❑Sorinkler ❑Demolition ❑Chanae of Use
<br /> ��SCR�pTiC1�QF 41VQRK�
<br /> ��GGNS 7�'��.G� —� '/tt� C/�/�"►.c c�f-'1/L�tJId �/�
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> � �a.
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<br /> n��r�e,�e►wer,�w ��!�!y!1�APP�l�A���*"V �L�d!!�!1!B!(�� ��E��lE�A�P��C�!TIOM �
<br /> __ _ _.
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixtures #of Lisf of Fixtures #of Lisf of Fixtures #of List of Fixtures
<br /> Fixtures Fixiures Fixtures Fixtures
<br /> A/C—Air Hancllina Units _ Heat Pumn Toilet Ra�kflnw Preventer flnside Ridai
<br /> lrorced,v�r�ystems --�---— un�t Neaier _� �_ It�atntu� -- S �unnai-------- �
<br /> _ _ _-.
<br /> In n;,.;.,� � � 1 In,.:i.._ 1 1 li ,. ...a...-.,nni..,,�, o,.,,:...i 1 In.-:..i.:.,� - i
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<br /> ...w., , . ...,,,.., �u.u.., ...�.,, 5.......,; . .�_..... ..� . .,.s�...,s,,,
<br /> Water Heater Refrigeration Shower Floor Urair �
<br /> Gas Fire�lace Wood Stove KitchPn Sink�� pis��,-,.SFi -'- — -- T;�,;; `
<br /> Gas Ranae Ductina Dishwa�"er ' ��=:�.;i�rain� '
<br /> ;_....,...... �.:.. .............. : ,,,._, . ...._ ._..._-• - ;• _ _., ...,., .
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<br /> Rann� Hn��l � � I � �\Nater Heater �Other �
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<br /> iL. I�.,l�{ I�qll � ! ! � 1�)I11llIJCIVII.C/U(J��IVIV4Jl--l�:i �`.I�.IC'i .
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<br /> i:V'ulliiJCi iIl I-lCQUS E E 1 ! I �
<br /> ACKNOWLEDGEMENT:!have reviewed this apolication and confirm the information con!ained herein is true and correct. !h/ork done Aursuant to this oermit must r,omplv wiih
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