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����ViY�'��PLIC�Y9CC��u <br /> �1�9L�{�9G/�i11ECL��f�ICAL/{�LU�fV�9f��/�lG�d/���I&�����/D��fiOLIYO�d�I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRL-ET,EVERETT,WA 98209 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everefteps@everettwa.gov� ydww.everettwa.gov/permits <br /> (�lue or�IacFe InF��.�ly_�leas�) ���d�t�°P�LT� Ih1�'���lll�a`PI�1� - <br /> PROJECT SITE ADDRESS: (�S'�L,�-� �L�L:��/�'L-'y�-' �`��� PROPERTY TAX#: ��G` �% 3j�-�-�C;�'J�C��`,`/z�Gl <br /> LEGAL for new construction: ShorE Plaf/subdivision I_ot No. (attach copy of long fegal description) <br /> . . ��N`f'A�`i'.If�t��R01flA`Y'I�IV . . <br /> OWNER NAME: /`/��L�j�i,� �'1i(i '/� �C1 TENANT NAME(If Commercial): <br /> OWNER MAILfNG ADDRESS; sTrzEEr lc'�ilG N�UG'%?G�'�'� GL�+`�� <br /> cirr �%v�l'2�'77 srn-rE /%f;�,1 zia � r� 1c_j <br /> OWNER PHOIJE: OWNER EMAIL: <br /> _.,_.. _.._ ._..,.. . �.... . ......... . ........ _. ,_. ,..,. ...._.. . . ...._.._. ,.,.__.., .. ,.,... .. ,.,_ ..,.._ ., .... _ .. ._... _.. .......,. .. .._.. ._. ... .. ..... _ ...... ,. ..,. <br /> CONTRACTOR NAME; �v�C�a(�-(�� �1Tf��Co� '�$¢����bL(,P r/.�(., <br /> CONTRACTOR ADDRESS: sTReer '�I 2'D �/�l� �cU C� <br /> ITY t"rUCsyc��� STATE (,�(/.f� ZIP `�� <br /> CONTRACTOR PHONE: �`Z�✓.-`�ij��`�(� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): �(Jges`rZ�.�'js�2,�� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): f,;�fj �" <br /> . ........ ... ...... . . . ._... . ......_....... .... .. ._.,..._..... .. <br /> PRIMARY CONTACT: ❑OWNER �.CONTRAC t OR ❑OTHER(Please Specify) <br /> CONTACT►dAME:� CONTACT PHOI�E: '���_�S�d���f� <br /> i�'�l�'IZ�L- �G. �t� CONTACTEMAIL: yY�1j�l�l�° °'� ��",��i�`����� <br /> �UILDIN(a PERIViIT APPLICl�T1.ON ' <br /> Existing Use oi Building: � ContracE Price of Work:$ � Zt��C''� <br /> Proposed Use of Building: Heat Source: �Gas ❑Eleciric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Atfached ❑Dupicx ❑Multi-Family-#of Units: f�Commercial ❑indusfrial <br /> Type of Project: ❑New �Addition ClRemodel f�EZepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ���'v�Lc-�� ����<rt:�� �'� !'—TL'r� Ct� l�(��t� �s�t� �,:�cc lt:�C,��t��� �lfti��ji�a��f l��T�`� <br /> ASSOC(ATED BUIL�ING PERMIT#(if applicable): <br /> IV1��bAN1�AL,PERM1`�'APPI�ICA`fl�4d -- I���iM61td� P�RMI`i'�1�PL1��`P!�{W <br /> Type of Projecf: _Nevr� Addn _Afferation _Repair Type of Projecf: _New _Addn __Alteration _Repair <br /> m <br /> ��f List of Fixtures � List of Fixtures ��f List of Fixtures �°f Lisf of Fixtures <br /> Fixtures Fixfures Fixtures Fixfures <br /> A/C—Air Handling Unifs Heat Pump Toilef [3acf<flow Preventer(Inside Bldg) <br /> Forced Air Sysfems Unit Heaier [3athtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Neater Refrigeration Shower Floor Drain <br /> Gas Fireplace VVood Stove Kifchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Wafer Heater Ofher: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �f€���t�iP�C�.�R/��7 fl�P�i���➢�R9 ��°�`��fi�fi <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�l have reviewed this application and confirm fhe information contained herein is t�ue and correct. Walc done pursuanf fo thls permit must comply with <br /> current federal,state,and local law. The granting of a pennit only authorizes approved wo�k and no deviations therefrom.Deviations must frrsf he authorized rn writrng fiom the <br /> Building Offcia!before being authorized under any circumsfance.l am the owner,or I am authorized by the owner of this properfy to perform the work for which application is made, <br /> and l comply with the Stafe Contracfors Law 98.27 RCW and 296.2o0A WAC. <br /> Cify of Evere(t Official Use On/y <br /> PERMIT# <br /> '��� �Z � �� � � !��� i'? ( 1 � � � <br /> i,� <br /> OwnerlAufhorized Ag� S' nafure Dafe (}��vised 5/20/2016) <br /> , � � <br />