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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN / SPRINKLER/ DEMOLITION <br /> 0114/44f, 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@everettrya.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: +2.7 <br /> LEGAL,for new construction: Short Plat/suttuhisitta PROPERTY TAX#: <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: e <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADD- SS„ sT _ .. l <br /> 72 L SE <br /> om ` v ,e <br /> STATE Zi,OWNER PHONE: <br /> t/jVtI ypew ++✓y <br /> 35 <br /> y [OWNER EMAIL: <br /> CONTRACTOR NAME: . ° II to C <br /> CONTRACTOR ADDRESS: rt 4. Q . <br /> COY ink / 7 <br /> STATE A. eu, d ► t+! ! <br /> CONTRACTOR PHONE: 2, Q 0 <br /> 60 CONTRACTOR EMAIL �, 1CONTRACTOf -LICENSE#fRE>�FJfREL`E): ��.I 1. .CO <br /> L� -AR CITY OF EVPFtETTBU51NES5LIGENSE (RE4lJlRED): ��_ <br /> PRIMARY CONTACT: OWNER L�s�ONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 4-2.5 25C? D <br /> CONTACT EMAIL: (6✓„ (`�✓ Cry L CL>' ' t <br /> BUILDING PERMIT APPLICATION iN '_ .. <br /> existing Use of 3ufidinq• � � <br /> Contract Price of Work: a 2-10,0 <br /> Proposed Use of BUildln <br /> Buitdin T Heat Source: Gas Electric DOther <br /> ►/SFR-Detached OSFR-Attached ODuplex ❑Multi-Farnily-1F of Units;____.. <br /> Ty a of Project: ❑New ❑Commercial ❑industrial <br /> OAddition ❑Remodel ORe <br /> DESCRIPTION OF WORK: Parr OT.l. ❑St+n ❑Serer kler ❑Demolition O han,a of Use <br /> 1l- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> Ml~CTA" <br /> NICAI PERMIT AI"PIICATION <br /> Type of Project: _New L Addn Poect: G wPERMIT:AP'PLICATION <br /> Alteration _Repair <br /> I#of Type of Project: New Addn Alteration _Repair <br /> Fixtures _List OfFixtures #of #of <br /> P7ztura List of Fixtures __ -Listof Fixtures #of <br /> 1 lxtures _ a-- List of Fixfurev—— <br /> AIC-Air i-iandlin• ()nits <br /> Fixtures <br /> Forced Air Systems Heat pump Toilet <br /> He <br /> Unit Heater Urinal Prevrrtter(Inside Bldg) <br /> Gas Piping -- _ . 6afhttti� Urinal <br /> Water Heater Bviler Lauator (tAtah Basin) <br /> Refrigeration L7rior Dr Fountain <br /> Gas Fireplace Sttawer Fluor€gain <br /> Wood Stove Kitchen Sink bis oral <br /> Gas Rant® Ductin Graase Tran <br /> Clothes t e Hookups OtheDucts Dishwasher Roof Drains <br /> Cane Dry Clothes Washer Medical Gas <br /> Ezhrz a Fan Ater Heater Other. <br /> Sink(Sarvlce/EarJMo .sink <br /> Other: <br /> PF4INKIER'C uUPP 6.13)N SYSTEM <br /> hernical or Water No. of Heads <br /> ACKNOWLEDGEMENT:!have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must complywith <br /> current Building Official before being authorizehe d ugndertng of a permit only authorizes any circumstance.lam the owner,or I am authorized by the owner of this properly to perform the work for whichn writing from the <br /> work and no deviations <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> application is made, <br /> G City of Everett Official Use opt,- <br /> &I 1 4 2 1 D PERMV.IJ,T,{t� I 1 ` 0(92— <br /> Ow <br /> Ower/Authorized Agx Signature r• l7, 1 Y ` (n <br /> Signature Dale C <br /> (Revisal(9(23120/6) <br />