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<br /> BUILDINECHANICAL I PLUMBING I SIGN I '-'INKLER 1 DEMOLITION
<br /> CITY OF EVERt 11 PERMIT SERVICE 1 - –
<br /> j 3200 CEDAR STREET,EVERETT,WA 9'! i
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps©everettwagov�[� I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: C" Dr PROPERTY TAX#: s. 6 0 Sbc>Cfa
<br /> LEGAL for new construction: Short Piatlsubdivision Lot No, (attach copy of long legal description)
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<br /> OWNER NAME; Alam nc,_ C% S TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET R D fl 1.,P('
<br /> City V-c,e4 /1/4STATE Z.iP iefT3'
<br /> OWNER PHONE: "T s---a 3Q-$30 co OWNER EMAIL:
<br /> CONTRACTOR NAME: NW t3c,%Tintti€?(`k.5
<br /> CONTRACTOR ADDRESS: srREer (�$/. e�Z I
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<br /> CONTRACTOR PHONE:6125-9).8-�f } CONTRACTOR EMAIL: ,tC,fj{,11b 4-ies:wo,r-ks ca A,'
<br /> CONTRACTOR LICENSE#(REQUIRED), Idl j3 y7B ,S` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED). S 7(g'
<br /> PRIMARY CONTACT: FLOWNER 0 CONTRACTOR 0 OTHER(Please.Specify)
<br /> CONTACT NAME: CONTACT PHONE: q - 2 3-2- g 30.
<br /> vY' e L v ( S CONTACT EMAIL: s.E,•for
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<br /> Existing Use of Building: Contract Price of Work:$ t!
<br /> Proposed Use of Building: Heat Source: &as °Electric °Other
<br /> 'Building Type: ©SFR`Detached ❑SFR-Attached °Duplex °Muiti-Family-#of Units: °Commmercial ❑Industrial
<br /> Type of Project ZINew °Addition °Remodel ❑Repair °T.I. °Sign ©Sprinkler °Demolition °Change of Use
<br /> DESCRIPTION OF WORK:
<br /> { . :)ISo - .1 nek.IZAre,I ts 01— c.,✓ 7-641 K
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<br /> ASSOCIATED BUILDING
<br /> PERMIT#(if applicable):
<br /> 6 Tptrtiolotoptirw i> d^ "
<br /> S < r a02WE .� ..sv m .4. t ✓,iy
<br /> Type of Project New, Addn ,_Alteration Repair Type of Project New _Addn Alteration _Repair
<br /> #of List of Fixtures t urres List of Fixtures #of Fixtures. List of Fixtures #of Fixtures
<br /> Fixtures Fixtures List of Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> j Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease.Trap
<br /> Gas Range ' Ducting . Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other.
<br /> Exhaust Fan Sink(Service/Bar/Mopfetc.) ' Other.
<br /> 'Chemical or Water I [No.of Heads
<br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is tare and correct Work done pursuant to this permit must comply with
<br /> current federal,state.and local law.The granting of a permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized in iwiting from the
<br /> Building Official before being authorized under any circumstance.lam the owner,orf am authorized by the owner of this property to pertorrn the work for which application is made,
<br /> and I comply with the State Contractors Law 18.27 ROW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> • 2c- 7 PERM61 V n` f I2,- 01'4
<br /> Owner/Authoriz-•Agen = gnature Date (Revised 9/23/2016)
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