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<br /> ,t wa-r 3200 CEDAR STREET,EVERE'lT,WA 98201
<br /> ------,---' (F)425-257-E i FAX 425-257-8857 I(E)everetteps@evereN, I I vww.everettwa.gov/permits
<br /> 06111,P.115015:0 : . .- IP.6 Ojk .___ _ 11L-4.10 114111�7f�1�! - ... _ . . .
<br /> • PROPERTY TAX
<br /> 'PROJECT SITE ADDRESS: M-2- ' ,ts tL` (attach o of long legal description)
<br /> LEGAL for new construction: Short Plat/subdivislonLot No._ _ ( copy------.--
<br /> I ,• .. c®I 1',AtT�Ir17I'c•0lia1 AT' ai - - - •
<br /> .`,� ,••• �• - �r • � - ,, TENANT NAME(If Commercial):
<br /> OWNER NAME: / - _ r =
<br /> ;OWNER MAILING ADDRESS: STREET K y 21J /` ZIP Zj
<br /> �°
<br /> Cfe' '"' STATE z
<br /> OWNER EMAIL:
<br /> DOWNER PHONE: fZ16
<br /> f K .......... .... .. .... .:... . . . .,. ..,. �.,, ..p...., .
<br /> ,CONTRACTOR NAME: "CLU-tom_,r "`Qt''-- 7 '., v
<br /> (CONTRACTOR ADDRESS: STREET 2-1 Z0 A- Le_
<br /> STATE LA* ZIP
<br /> CiTY • 'r } �,��
<br /> 14- CONTRACTOR EMAIL: t ®'•� t"-'a-r�
<br /> fC01`ITRACTORPHONE: CIf2 �- �` ���
<br /> , CiTY OF EVERETT BUSINESS LICENSE (REQUIRED)' /�' ���
<br /> CONTRACTOR LICENSE#(RF_QUIRED)�.C'ti�2 ` ms's !..... .,.,.,.,, Y,. ,- ,., n....,. N . ..,.r..
<br /> ,»,....ms..,,...,µ .,.,.,..,,....,...,, .,.,,.,r• ,�,,.
<br /> 'PRIMARY CONTACT: ❑ OWNER ►4 CONTRACTOR ❑ OTHER(Please Specifj)
<br /> CONTACT PHONE: . '.ZS ,j® 07257
<br /> CONTACT NAME: ,
<br /> 'LI;is-) CONTACT EMAIL: ij G/6-5%YIGFi4144-14 -
<br /> :•. .,:,;; • - , - .. •BUIL,DING,PERI4"IiT: P.MATI®1td • -__- - • -- __ ._-
<br /> -- __------_ - Contract Price of Work:$___ ___._.
<br /> Existin_ Use of Buiiding:
<br /> Heat Source: teGas ❑Electric ❑Other
<br /> Pro•ased Use ofBuiidin•: ❑Commercial ❑Industrial,
<br /> Building Tyse: 74 RDetached ❑SFRAttached ❑Du•lex ❑Multi-Famiiy4:SUjnkier its: IIDemolition ❑ChangeofiUse •
<br /> DESCRIPTION OF WORK:
<br /> Type of Project: DNew IIAddltiOn L7Remodel /C7 Repair En.(. ❑Sign P ��� `� � �
<br /> (AA- { Lcr 6 r,1,. 4.. Ks)eqj--- w"
<br /> °r 4te .' ' ---z.9,,
<br /> •
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): _ ---_.._— ---- --- =-�
<br /> __ dfILLINjl PA----- f l Type of Project: New Addn Alteration _RePaii_
<br /> Type of Project: New _. Addn Alteration _Repair List of Fixtures
<br /> i#of #of List of Fixtures , L4 ofist of Fixtures Fixtures
<br /> Fixtures List af.Fixtures Fixtures Fixtures
<br /> i-oilet Backflow Preventer(Inside Bldg)
<br /> Bathtub
<br /> A/C-Air Handling Units i Heat Pump Urinal
<br /> Unit Heater '
<br /> Forced Air Systems i Lavatory(Wash Basin) Drinking Fountain
<br /> Gas Piping Boiler i
<br /> Water Heater vr4rAii Refrigeration Shower Floor DrainGrease Trap
<br /> Wood Stove Kitchen Sink&Disposal
<br /> Gas Fireplace Dishwasher Roof Drains
<br /> Gas Range Ducting ! Medical Gas
<br /> Other: - Clothes Washer
<br /> Clothes Dryer Hookups Water Heater Other:
<br /> Range Hoan — Sink(Service/Bai/Mop/eta): Other:
<br /> �,Exhaust Fan •
<br /> .. oi-. . ...../ A[ .gl s.d l:.if-gT.rg, .
<br /> Number of Heads _ _ - -- with
<br /> 1CKNOWLE 1, 1 have reviewed th
<br /> application and contfm7 the information contained herein is true and correct.Work dons pursuant toads permit must comply
<br /> n writing from the
<br /> wrrdnf federal,state,efoandglocal law.hThe grantingan of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized circumstance,I am the owner,orf am authorized by Tha ownerf this property to perform the work for whirch application is made,
<br /> Wilding Official before being authorized and Y
<br /> nd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only
<br /> ‘2,",,s.., )4/6_
<br /> { PE \
<br /> � 11f
<br /> yl ') _____---------
<br /> ...,,...ic,...%-,ort Arrant Signature
<br /> Date (Revised 5/20/2016)
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