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�C��llil�"APt��l��l�90tV
<br /> �����{�9G/�EC����19C�,L/��.UY��9�lCs I�9C��d I���I����i�/��'�fi09 IY'o�dV
<br /> CITY OF EV�RETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EV�RETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everefieps@evereffwa.gov� wv,nv.everetfwa.gov/permifs
<br /> (E�Itae or I�I�cle It�[��r�Iy_�l�as�) ����A��`i"�A`��IR1��G��lf1�`PI�W . .
<br /> PRO.IECT 51TE ADDRESS: � `i G�'� •,' 6L��' PROPERTY TAX�:
<br /> LECAL ior new consfrucfion: ShorE Piat/subdivision Lof No. (attach copy of long fegal description)
<br /> . - . . . . .
<br /> � � � � (�;�N`P���.I�I��RM��1'IAEd -
<br /> OWNER NAME: ��CJpL�/�.',n ��� C//'� TENANT NAME(If Commercial):
<br /> OWNER MAILINGADDRESS; sTREer �c/���� CL�J2L��L`��� �'�'� =
<br /> cirr �UL�2� srn re �ti:�� ziP �^ '�7 2
<br /> OWI�IER PHONE: OWNER EMAIL: ,r �� 4•?r �� ;' ? : � ��jJ�c-�
<br /> _.�_._..._..._,..,.._�, ..�... -- ._....... ........ _ . .... ......... .. ...._ _ _.. . _ , . .,. .. .. „_ ....._ .. ..,.... _. .. ...,....,,,.,_-. ,-. . . .,. . �,., ,....
<br /> CONTRACTOR IVAME; �U����pV ��'L�[�� �Y�����/1�(,�1-6-C-
<br /> CONTRACTOR ADDRESS: sTREEr '�I�� ��.l�l� c�cU t�
<br /> �7y �U�� STATE �.�-- ZIP ��7�
<br /> CONTRACTOR PHONE: �`2�✓-��j�P`�/�!� . CONT`�'ACTOR Eftr(AIL• �'�✓t(+{�C� (i�' �'S" ,'�JCI,r� -���'-
<br /> CONTRACTOR LICENSE#(REQUIRED): ��Jg�P�(jS p�T��' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): iJ 6 �
<br /> , ..., . ._._,... _.._... .... ...... ..... ._., .. _ ........... . .., .
<br /> PRIMARY CONTACT: ❑OWNER �.CONTRACTOR ❑OTHER(Please Speci'ry)
<br /> COPlTACT NAME: CONTACT PHOt�E: !���s���s���l�
<br /> Uvl�l�%� i�k� - coNracr Emai�: �M�r�lt� ��' ��5��%�Z�L;'1 .�z_ .
<br /> - �UILUINCa E��RNi17'��PLI�ATIBN � . , .
<br /> Existing Use oi Building: �-�(,'� C�� �rl�ti �F' Contract Price of Work:$ �c�
<br /> Proposed Use of[3uilding: � �' (;��� Heaf Source: �.Gas ❑Electric ❑Ofher
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Mulfi-Famify-#of Units: [�1Commercial ❑Indusfrial
<br /> 7ype of Projecf: ❑New ❑Addifion ❑Remodel �Repair ❑T.I. ❑Sign ❑S rinkl2r ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: � . � + �TL/
<br /> t��;��:�L � >����� ��� ,,�,��- �,�������'j G�����,�,� �t�:�,��,�: � �� ����t �
<br /> ,
<br /> ASSOCIATED BUILDI�IG PERMfT�`(if applicable): T_ _ __ _
<br /> ' .NI��I�ARII��1�.P�RN(1`�'A���►f��l`PI�k�3 — P��►fV1�lEd� E��F�MI`i'�PL�l�1(�,�"A�YtJ
<br /> Type of Projecf: _New J Addn _A[feration Repair � l'ype of Projecf: �New _Addn _,Alferation _Repair
<br /> �°f List of Fixtures '��f List of Fixfures ��f List of Fixtures �°f Lrst of Fixtures
<br /> Fixtures Fixtures Fixtures Fiztures
<br /> A/C—Air Handling Uniis Heat Pump Toilef Backilow Prevenfer(Inside Bldg)
<br /> Forced Air Sysfems Unit Heafer 6atf�tub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinkin,y Founfain
<br /> Wa'ter Heafer fteirigeration Shower Floor Drain
<br /> Gas Fireplace Wood Siove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducfing Dishwasher RooT Drains
<br /> ClofFtes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Wafer Heafer Ofher:
<br /> Exhaust Fan Sink(Service/I3ar/Mop/etc.) Other:
<br /> . �P�;�liS���PF�/���P����G��9 �3°�Y�VV�
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.�l have reviewed this applicafion and confirm the information confained herein is frue and correct. Wor/r done pursuant to this permit must comply with
<br /> cu�rent federal,staie,and locallaw.Tlte grantinq oi a pennif only authorizes approved wo�k and no deviations fherefrom.Deviafions musf first be autho�ized in writing from the
<br /> Building Official be�ore being authorized under any circums(ance.l am the o�;vner,orl am authorired by the ov✓ner of this properfy to perform rhe work for which application is made,
<br /> and l comply�vith the Stafe Contractors Law 18.27 RCW and 29G.2ooA WAC.
<br /> City of Eve�eff Officia!Use Only
<br /> 1 PERMIT#
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<br /> )�. "� �.��� ��j� i', � --1�v.1 . ��`�i-J
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<br /> � �-�^ufhorizecf ntSignaYure Daie (Revised5/20/2096)
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