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• • ii=er ae>uu . 5 ---- ' <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetfeps@everettwa.gov( wvuw.everefiwa.gov/permits--: ._ . . • • • • - <br /> • ��mDl� • • <br /> l$ r t�aci�In1��•}sul[�iP0.11,4 .•0a�� . .. _ �.._ <br /> ROJECT SITE ADDRESS: q.0---/ -lbw( 1`l'Uif? PR*- ;•' Y TAX#: <br /> ;GAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> INNER NAME:, /---4Q/t,,6a h. ' > , JTTENANT NAME(If Commercial): <br /> WNER MAILING ADDRESS: STREEr OW( i6�- / t 4 ,#/L <br /> CiiY // { <br /> 17,-:-.0.,9tern STATE Wi'i • �P '9�l <br /> ! • <br /> INNER PHONE: .. f. _.,. ..... , IOWNER EMAiL:_.. . . .. ....... P• _. .. .. M.a.ONTRACTOR NAME:w ?�—i?at 1.1. A� <br /> ONTRACTOR ADDRESS: sTREETl ZO PA—e. t. <br /> CnY tz STATE WA ZIP q 2 <br /> DNTRACTOR PHONE: t`t2) '252-- 5 (.4- !CONTRACTOR EMAiL t-2-.04.-46.1.6.-%01 g.z-. 9 Ai <br /> CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 .1;1j <br /> DNTRACTOR LICENSE#(REQUIRED) 2 `R -t-'— ux k w- ---•.UWfl. - . ^ ^ "" <br /> ..4vere.r✓w.aY+.�•nrw.M�.n.wl'H",•a3-. saw W..Y++.^aW..ai.m <br /> rm..• ro••w r,..* mNp'sYw�wvow.sa+a.+a+v.s. YM1•r a w• <br /> RIMARY CONTACT: 0 OWNER `CONTRACTOR Q OTHER(Please Specify) <br /> ONTAGT NAME: CONTACT PHONE: (L 5 <br /> c) 01 0-72. <br /> • <br /> i LL L CONTACT EMAIL: t,A.,4 a 5.5i'kt r - <br /> • <br /> . ... .• .' . <br /> . SUILDING.,PERNitT�)i31aL[�ATI®N <br /> cisting Use of Building: Contract Price of Work:$_Z • <br /> oposed Use of Building: Heat Source: ElGas 'lectrio El Other <br /> Aiding Type: QSFR Detached QSFR Attached QDuplex ElMuiti-Family-#of Units: <br /> commercial QlndustrIal <br /> rpe of Project: ONew QAddition LJRemodel ,Repair OT.I. QSign QSprinkler ElDemolition QChange of Use <br /> • <br /> ;SCRIPTION OF WORK: ��eGLL(�t �� ' <br /> Ca Vic:- 6cc � <br /> • <br /> iSOCiATED BUILDING PERMIT#(if applicable): <br /> ` .MECHANICAL pI PaV1 '='APPlI..IGATtO. • • • - PLUMBING PEI MI .-.0.0 LICATION <br /> Type of Pro •__._ ___Addn Alteration Repair <br /> pe of Project: Neva►.._. Addn Alteration Repair YP Project: New _ <br /> ) #of <br /> List of Fixtures ! List of Fixtures <br /> xtures <br /> List of.Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> �Toilet Backflow Preventer(Inside Bldg) <br /> A/C—Air Handling Units Heat Pump Bathtub Urinal <br /> I <br /> Forced Air Systems Unit Heater <br /> Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Gas Piping <br /> Water Heater Refrigeration Shower Floor Drain - <br /> Gas Fireplace Wood Stove Kitchen Sink Disposal Grease Trap <br /> Ducting Dishwasher Roof Drains <br /> Gas Range <br /> Clothes Dryer Hookups Other: Clothes Washer Medical GasOther. <br /> Range Hood Water Heater <br /> Exhaust Fan ` Sink(Service/Bar/Mop/etc.), Other: <br /> • <br /> SPRINKLER/SU.IPPRIE Sa®9!!SYStEM: - :..- <br /> -"Number of Heads _- <br /> KNOWLEDGEMENT.'i have reviewed this application end confirm the information contained herein Is true and correct. Work done pursuant to this permit must comply with <br /> o deviations therefrom.Deviations must first be authorized in writing from the <br /> ,enf federal,, aauthored unded local law.The r any circumstance.I am the owner or am authorized ng of a permit only authorizes approved work and by the owner of this property to perform the work for which application Is made <br /> fding Official before being <br /> f/comply with the State Contractors Law 18.27 RCW and 296.200A WAC.VL — g4e 1 -2,1— CWity of Everett Official Use Only <br /> y�I � �� <br /> PERI Y � � <br /> ........IA.a P.nr7•fcrr Avant S lanature Date (Revised 5/20/2016) <br />