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PERMIT APPLICATION <br /> 467.1. BUILDING / MECHANICAL I PLUMBING /SIGN I SPRINKLER! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black InkJ'Otily Phase) " `PROJECT SSITE4INFO $MATION�'�^�" <br /> PROJECT SITE ADDRESS: 7�. 4011A,, FL.- 1 <br /> 4 PROPERTY TAX#: <br /> ,LEGAL for new construction: Short Plat/subdivisl -- t�zt No.' (attach copy of long legal description) <br /> CONTACT INFORMATION ' " <br /> OWNER NAME: i a' <br /> IC--Ii\ .ra,. R �,, TENANT NAME(If Commercial) <br /> ex <br /> OWNER MAILING ADDRESS; ::EET <br /> -7'( P <br /> a157ATE }j 1 <br /> OWNER PHONE-T-425 2 58- ZIP <br /> 340 , OWNER EMAIL: <br /> CONTRACTOR NAME: t -' }`f ci VI tr <br /> _e. <br /> CONTRACTOR ADDRESS: STREET `L4,-- rOc <br /> ciLociN <br /> --,,,_ CIN STATE .� I�"- ZIP t,L? {*'� <br /> CONTRACTOR PHONE: C- L 2.. q <br /> DiSR <br /> EMAIL,/ 41,40 �o '� � 0 � �ni .CO <br /> -- CONTRACTOR LICENSE#(REOU1RED);-2 LTfei... s '�' 3 ..._ <br /> �.,. �� CITY QFeVERE"f'4'Stt31NE55-ttCEN3E#{RE@t1tRED}. 06p i g _.__ <br /> PRIMARY CONTACT: 0 OWNER IP CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE L .,.ZS 250CIS-C) <br /> 1/ dallo EMAIL: ita/Lb C.-OI et d 4 , <br /> BUILD1N SFERivire OVLI4Atioh " p , a" <br /> Existing Use of Building: Contract Price of Work:$ . <br /> Proposed Use of Buiidino: <br /> Heat Source: s'as DElectric ❑Other a <br /> Building Type: 9SFR-Detached OSFR-Attached ODuplex OMuIIi-Femil,-#of Units_�� <br /> ONew ❑Commercial ❑Industnal <br /> Type of Project; F Wo ❑Addition ORemodel ORepair ❑T.I. (]Sin OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 'Kef <br /> l <br /> ..ASSOCIATED BUILDING PERMIT#(if applicable): <br /> APPLICATION ype of Project: IALtPERMI`T' <br /> MEOI�AAIIC <br /> `-'"F'1,:'llflll8ltdd'I'EI`tMl;�'tr1'k�4PLiG <br /> New Addn Alteration air Re <br /> #of #of I? Type of Project: _New _Addn _Altarallonanon <br /> _Repair <br /> _Ffxtures „.______List_gJ�xttltits it _L st.ot-Ffxiures #of <br /> kiures x(uras List-of-Fixtures-___..___. #of <br /> .._...ix_._e_..._...._._._,_,_ElsNof irllrtt3rt35— _—.... <br /> A/C--Air Handling Units Hest Puns Fixtures - <br /> Forced Air S+ p Toilet <br /> Systems Backflow Praven(er'Inside Bid ) <br /> Unit Heater Bathtub <br /> teas Piping Boiler Urinal <br /> Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> f efrigt ration Shower <br /> Gas Fireplace Wood Stove Floor Drain <br /> Gas Range. Kitchen Sink&disposal Grease Trap <br /> Ducting Dishwasher <br /> Clothes 0 er Hookups Other: Roof Drains <br /> Range Hood / Clothes Washer Medical Gas <br /> Exhafist Fan _ Wafer Heater Other: <br /> Sink Se vlceli�artMopp'ratc.l Othnr <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein Is true 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 a <br /> ppoved work and noBuilding Official before being authorized under any circumstance.lam the owner or am authorized yithate ownns er of th s property to perfaDeviationstnn thefirsta wauthorized in writin from ork for which application is made. <br /> and 1 comply with the State Contractors Law 18.27 RCA/and 296.200A WAC. <br /> r'1 City of Everett Official Use Only <br /> 1....4 ( PERM T j <br /> ,•a `7v1q•l8 �d O�(�I <br /> Ow rrriAutirorizod Age Signature <br /> Cat r --„—_ <br /> L (Revised g123/207&J <br />