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<br /> PERMIT APPLICATION
<br /> BUILDING 1 MECHANICAL 1 PLUMBING/SIGN/SPRINKLER/DE€MOLiTI®N •
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)426-257-8810 1 FAX 425-257-8857 1(E)everefteps@everetfwa.gov 1 ,www.everetfwa.gov/permits .
<br /> ,( (ui 'or is[alc(Ink®.>ti.Pte e) ' �/• . PROMO*SitTt im,kM tti iOiki • • , •
<br /> PROJECT SITE ADDRESS: f g j7 tl//a yj` 1 v PROPERTY TAX#: I
<br /> LEGAL.for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) '
<br /> j - .©ottirA .limPoa 4i®!�1 .' ., . . • .
<br /> OWNER NAME: t t WA �r•2'{A) TENANT NAME(if Commercial):
<br /> OWNER MAILING ADDRESS: STREET //'(-7 /4 6 kt' - �9V'6- j . /�
<br /> � ,cm( lam ..` Zk✓ STATE; tet-Ar4 - ZIP -1 6 (f,I
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<br /> ;OWNER PHONE(IfeCi ,..� ' VW _,.. ,....,..a�.._m OWNEREMAIL:.,. v ..„,.. •..,.... ,� ....,.,.,..,,..� ....-. .., ,...�. ..,,. ..,
<br /> CONTRACToRNAME: Ct1 ad..6MAJ aTarn( e`4Ca” t 1-e- rt
<br /> CONTRACTOR ADDRESS: STREET `2 (?A) 64CA AU
<br /> cin S umesrr STATS (s4.!Pc— ZIP /G2O/ ,
<br /> CONTRACTOR PHONE: 4°Z5-252.-31Ii . !CONTRACTOR EMAIL: 1
<br /> CONTRACTOR LICENSE#(REQUIRED): E(J$s`}!.,5S®2,20 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):, 0 6_.•• r -
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) .... ..,. .w�•,w_.... .....w._.., _.....�,. ..._...
<br /> CONTACT NAME: -, CONTACT PHONE: 475a2-5-7., //9
<br /> g Oki__% . CONTACT EMAIL: ge..,-1-C.Ve 56e ie.-It. L.;y-y,:-.,. .
<br /> . • • • '' '• )30.1 D1NG P1',Rf�l1T AiNam sfri.o ( ' . • • • -
<br /> Existing Use of Building: I Contract Price of Work:$ (.5;Ca)/
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<br /> Proposed Use of Building: Heat Source: 15eGas ElEfectric ❑Other
<br /> Building Type: VI-SFR-Detached OSFR-Attached 1:1Duplex UMultl-Family-#of Units: ElCommerclal ❑Industrial
<br /> Type of Project: EINew DAddltfon EiRemodel ORepair CIT.1. ❑Sign ❑Sprinkler EDemolitlon E(Change of Use
<br /> DESCRIPTION OF WORK: CL.10- c0 jc.‘....- �„ p ,_ t x ..nA LI_ t1 t w...647_'4 Li�1.:� •
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): _
<br /> • ' :II/ cll1ANVXC4;, RIWtT APPLtC'ATf®kl • . PLUW I If h 10EgMIMIiTi �PPLi(CATJIOf •
<br /> 'Type of Project: JNew Addn Alteration Repair j Type of Project: New Addn Alteration Repair
<br /> #°f List of Fixtures "of List of Fixtures #°f List of Fixtures , #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units i Heat Pump ; i Toilet i Backflow Preventer(Inside Bldg)
<br /> 1 Forced Air Systems I Unit Heater Bathtub Urinal '
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> IGas 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 I Sink(Service/Bar/Mop/etc.); Other:
<br /> :'61iISiTa % I9;PPRO ON S YATEIw I
<br /> [Number of Heads
<br /> t CKNOWLEDGEMENT,•i have reviewed this epplicaffon and confirm the Information contained herein is true and correct.!Work done pursuant to this permit must comply with
<br /> :urrent federal,state,and locallaw.The granting of a permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized In writing from the
<br /> 3ulkiing Official before being authorized under any ci msfance.I em the owner,ori am authorized by the owner of this property to perform the work forwh/ch application is made,
<br /> nd I comply with the1 tate ontractors Law 1• nd 296..200A WAC.
<br /> �� i 1. -l Z' f
<br /> CityofEverettOfficial Use Only
<br /> MigA2-',.
<br /> PERMIT# �wner/Authorized Agent Signature Date (Revised 5120/20115) .
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