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'�_��.--- I'��i11�6�'A�'P�.BCAT'lOi� <br /> �����i�� �3U➢L.p11�G/�lfi�Ci IA�IICAL I �'LlJfl�l�ti�G I�6��1 /�F'R�f���L�R/�7EMOLt�fO�! <br /> CITY OF EVERETT PERMIT SERVICES <br /> r�-✓[��.ai%F'j <br /> 3200 CEDAR STREE],EVERETT,WA 98201 <br /> (P)425-?.57-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.yov/permits <br /> �_ _ [�.G'3����1T'�Q��p��'��6����.�G� _ _- - <br /> PRdJEC7 SITE DDRE S: � 5� f��, PROPERTY TAX#: <br /> �, ,� — �r�i � �� �kw' i <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long(egal description) <br /> ��G�9`�G'�C(�5'1 �_�9I��i�@i3L��f9��1 <br /> _ _ _ _ : __'- _ . . _ _ . . <br /> _ --- -- ,_ -- <br /> OWNERNAME: ���('q�.. ���C�/'r�l � �J'�py J�/7 !,L TEPIAIVTNAME(IfCommercial): �� ('L1�� <br /> OWNER MAILING ADDRESS: sraEEr �����U 5�2I` !U�n^zla- f� V l7 <br /> cm 'V� srn� ZIP ��/�c <br /> OWNER PHOfVE: OWNER EMAIL: <br /> __ _... .... <br /> _..._. .. _ . ... <br /> ___ . . .. . ._.......... _...... <br /> CONTRACTORNAME; (,� '��S P (�( �; L � <br /> CONTRACTOR ADDRESS: sraEer " "Z — �S� � N� <br /> CITY ��+ I�� LL STATE �/T ZIP �/ n ? <br /> v <br /> CONTRACTOR PHOf�fE: � , �7(i , C COPlTRACTOR EMAIL: /�t✓�'� I GIWI . I cJ l�ndl/I� C�+'� <br /> CONTRACTOR LICENSE#(REQUIRED): C1TY OF'EVERETT BUSINESS LICENSE#(REQU]RED): ���:�`IC <br /> __ , _ -_. _ . . _._ <br /> PR(MARY COMTACT: ❑OWNER �[CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT fdAME: COIVTACT PHOi�]E: , � G� �'�'�' <br /> `�'f'����' v�1�� CONTACT E1VfAIL: �' ' � � + <br /> t J� UV( ll l j�-S �l i'vl � � c �1�:1� � GG vw�, i <br /> � __,.....__ i <br /> - _ - _ �a�aa���a�i� ����dr����.���ru�� -- = - _= _ <br /> _ . -- , > , _ . <br /> _ _ - _ <br /> �����`= � <br /> Existing Use of Building: Contract Price of Work:$ i � <br /> Proposed Use of Building: Heaf Source: ❑Gas ❑Elecfric ❑Other j <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑industrial r <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprink(er ❑Demolition ❑Change of Use <br /> DESCRIPTION OF yllORK: � � (� ` ` <br /> c.l�}� <br /> � }i� i � S r�.�• G'"r,� �,'''� I�i�°� <br /> i <br /> � <br /> .qSSOCIATED BUILDING PERMIT#(if applicable): � <br /> ` 61���C�G3k�9���A+LI��G��!ld9�`�L��P�.E�aA'II'��Fd__ = _ `; ���719Ni1�9&i9c�'6���0ili6;H"��t�L,BC�"�"fl�i� t <br /> Type of Project: _New_ Addn _Alferation _Repair Type of Project: Nevr Addn �'�Alteration _Repair <br /> #of List of Fixtures ��f List of Fixtures ��f List of Fixfures #of Lisf of Fixtures <br /> Fixtures Fixtures Fi�ctures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) = <br /> Forced Air 5ystems Unit Heater Bathtub Urinal = <br /> Gas Piping 8oiler Lavatory(Wash Basin) Drinking Founfain <br /> Water Heafer Refrigerafion Shower Ffoor Drain ' <br /> Gas Firepiace Wood Stove Kitchen Sink&Disposal Grease Trap � <br /> Gas Range Ducting Dishwasher Roof Drains = <br /> Clothes Dryer Hookups Other: Clofhes Washer Medical Gas ' <br /> Range Hood Water Heater Other. I-rr..�'v � �� i; <br /> Exhausf Fan Sink(ServicelBar/Mop/etc.) Other: ;i <br /> `-..��I489G�11�0..�&�/�ltDf��IfB���p�� ���if'i�fiii;: <br /> __ ..._.:-_.__,..-,-- <br /> Number of Heads " <br /> ACKNOWLEDGEMENT.!have reviewed fhis application and con�rm the informafion contained herein is frue and correct.Work done pmsuant to this permif must comply with �� <br /> current federal,state,andlocallaw.7he granfing of a permit only aulhorizes approved v✓ork and no deviations therefrom.Deviations must first be aufhorired rn writing from the �i <br /> Building Otficial before being authorized any circumstance.l am fhe owner,or l am aufhori2ed by the owner of tl�is properiy to perform the wodt for which applicafion is made, � <br /> �' <br /> and!comply wifh the Stafe Contrac 9f3.27 RCWand 296.200A WAC. r <br /> City of Evereft Official Use Only <br /> PERMIT t� <br /> ` 3 l S � �I `��L :�b� �� <br /> OwnedA ' e d Agenf Signature Da te (Re vrse d 9 0/1 2/7_0 9.5) �' <br /> I: <br /> �; <br /> r <br /> � <br /> e <br />