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r 3200 CEDAR STREET,EVEREIT,1NA Jti:LU"1
<br /> -- (P)425-257-8i= FAX 425.-257 8857 j(E)everelteps@everetiw `1
<br /> www everet a.gov/permits
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<br /> t�RO QC. T:6IlTE If l ocR ATII0
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<br /> , /..(..._„,;...t.„.„, �/ pRaP;Ry1,4)(ROJECT SITE A.I)ORESS: t
<br /> of aco of. Long legaf description)
<br /> Lot No ( h 9 py
<br /> LEGAL for new construction: Shod PlaTsubdMsion }
<br /> .. '• - :. •- ` E'\IAP1i i\IAN1E(If Comlrlercial):
<br /> OWIUER NAMES .._ ( . ) J 20
<br /> OWNER MAILING ADDRESS: STREET r "` / ! �i
<br /> ell?' I .
<br /> STArE ZAP
<br /> -
<br /> �� j j. OIn111iEREMAi.: _ -
<br /> DWi�ER
<br /> :SOI TRACTOR NAME: f ? .? ?._s
<br /> STREET 2-i Zo -=.4t--<...4...- LU G,24I
<br /> ,sOl1ITRAGTOR ADDRESS. STATE (.,1. ;N, ZIP '�
<br /> CONTRACTOR EI�IAlI_` (�'/1-�`--�-�.1.'��tt.ltc: =f��`f�S
<br /> C GTOR PHONE: ‘4.-j-25- 'l _ (� 'F
<br /> aONTRACITE OF EVERETT BUSINESS LIGEn�SE• (R1;�2UIF2ET3) ( Y
<br /> .,ONTRAGTOP,LICENSE (REQUIRED): �iJ�f2�`.�ce►" ,. .... .._a-.r �.•r �_ .,.�__
<br /> PRII 'AIRY CONTACT: O OWNER ,CONTRACTOR O`OTHER(Please Specify)
<br /> CONTACT PHONE: E-ZS �j
<br /> CONTACT TaIANIE: •
<br /> GON TACT EMAIL :_ __
<br /> �i r�. &�5i 1 '� ','�'t
<br /> ��{ ill=tR--� - --
<br /> Pl-FtiM11 A PX_cATXoN _ - :' -
<br /> - 3U1I.I}.If+i�. � a '�-
<br /> - -- ---- -- - �Confrac�Pricy of Work°-• ;`• ----•
<br /> xisong Use of r Building.
<br /> Heat Source: / .s LiElectric I,]Other
<br /> Proposed Use oT'auiiding: _ OEommercial Qlndustrial
<br /> wilding Type: =�SFR-Detached OSFRAttached ODt1PIex 01k/11.11-Li-Family OSort"nkler )_1Derrlalition OGhange of Use
<br /> p pe of Project ONBW flAddition EI Remodel El Repair O T•I• OSign
<br /> Y �n�
<br /> 7ESGRiPTIOt+i OI=WORK: 1,i-:rte`' rK' �" Ct7-�'A lc
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<br /> - -- —.--
<br /> 4SSOCIATED_ __BUILDINGPERM_. IT—(if applicable): PX�I1J Ilia_ 1-,,gl%�,.b Q' `:s Pk�L.gc..At'Il9h' _ ..
<br /> _ L ICA' 1O �`Addn Re air
<br /> ���X�.Aldlli��,�:G?�a'�»118'�.��'_� - ----------e
<br /> ' - Alterafion .�. p.
<br /> ,, . Type of Project: ^___•Newt
<br /> Cyp-a.--0:1---;'114:,;(316°-
<br /> of Projsci: ^Ne}v ___: Rddn Alteration �,R2pair �of Lrsi of Fixfures
<br /> --IS of Fixtures
<br /> ,' r of � F%Yfures
<br /> ' #03 List of Fixfvres
<br /> of Lis#°r Fixtures Fixtures ' fixtures Backflow Prertenter(Inside Bldg}
<br /> Fixtures , Toilet •HeatPump Bathiu6 Urinal
<br /> Ao ce Air HSydling Units Unit Heater FDrinking Fountain
<br /> Forcers Air Systems Boiler Lavator7(Wash Basin) Drinking
<br /> Gas Piping Shower Grease Trap
<br /> Water Heater Refrigeration
<br /> tion Kitchen Sink Disposal
<br /> Wood Stove Dishwasher Roof Drains
<br /> Gas Fireplace Ducting Roof Dr Gas
<br /> Gas Range Other: Clothes Washer ©thea
<br /> Clothes dyer Hookups !Water Heater; Other
<br /> Range Hood , ®Sink(ServicefBarfrJlo}fete)
<br /> Exhaust Fan ilillillill
<br /> ;®
<br /> Number of Heads
<br /> rb and confirm the fnformaiion contained herein is flue and coorree Deviations
<br /> o k done pus Tr r�ke ahs pe Ed;n+s(comply
<br /> p°mw made,
<br /> urrent W eta state,and 1 haveaaw.Theed this ngapofau n
<br /> urrent Ofrici,', e g alto under
<br /> ofa.permit circumstance_
<br /> l am he o approved and.no deviations therefrom.
<br /> - before being authorized under any circumstance:l am the owner,or i am authorized by the o:vnet of this properly to Pe fon7i7 the.4 ork for which of ve E f Official Use Only eliding Orly with Cly
<br /> nd 1 comply the Cafe Contractors Law 7 RCW and 296.2008 L __-
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<br /> -N f / (Revised 5/20/2016)
<br /> ,�ii)i ....,,,,„,,,i .,,,,,',,,,, e .si t, Date
<br /> _„,z n,+anF Slanature
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