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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> II(61ae•orr bratck Ink®nl3,/.Pie ase) PIR'?JECT SITt IMw® MA` rON • • . <br /> PROJECT SiTE ADDRESS: 609 al DOA PL. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivlsion Lot No, (attach copy of long legal description) <br /> .. • CONTACT O MAq r®N • • . . . , .• <br /> OWNER NAME: 01.y1446 A U--c, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET X70'7 647 ,. ,,.l Z-00 /� • <br /> CIT( /?V "5 STATE w ZIP 9gCV <br /> OWNER PHONE: tiZ 5---'lb g-C,to IOWNER EMAiL:...,. .,... .. m <br /> CONTRACTOR NAME: E U ae,MAJ 6MTV:- `�(4C67I 2P7rc- <br /> CONTRACTOR ADDRESS: STREET °L I 0 � e+ t A4.)1;"" <br /> • <br /> . <br /> m( EUWaml r STATE LAI. - ZIP /t320( <br /> CONTRACTOR PHONE: 4-2-5,...2.5 1-3/it/ • )CONTRACTOR EMAIL: /j4/VdL C' 9.,.'5,011 et),A•. x-1 <br /> CONTRACTOR LICENSE 02.2.6 CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): LI q 55- • <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR °OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: (475-2.5-2.-V/9 <br /> ill14 <br /> rGJ pLe CONTACT EMAiL: MI 4 a eo9iii , e},-, <br /> . .' ,. 01L,I14NC3'Poi(/[IT APp.LE A`l',[O • . • •, . <br /> Existing Use of Building: itiO ai k t. Contract Price of Work:$ 500 <br /> p <br /> Pro osed Use of Building: /V P (.A,1.iIl66 eat Source: lJGas ['Electric IaOther <br /> Building Type: ❑SFR-Detached OSFR-Attached ['Duplex []Multi-Family-#of Units: ldlComrnercial [(industrial <br /> Type of Project: ❑New °Addition ❑Remodel DRepair °T.1. °Sign °Sprinkler ['Demolition °Change of Use <br /> DESCRIPTION OF WORK: G <br /> Aim/N G ( e'iill I. � S / CL/t/G'7'��-4,5 ,fid 6L WGU/m�/4i44.1.w <br /> &DU me,7'e.e U& -e:.--r©rtj AD 014 044-11 irAcli 41,0,-/-41A-A. ,frt., (4-4.-1 <br /> ASSOCiATED BUILDING PERMIT#(if apalicabie)` <br /> • ' .IViECQ .ANICAL PiERIVIIT APPLrCATfOM 1 . . • . PLUMEJNG Inglitillir APPLICATION • <br /> 'Type of Project: , New 4, Addn Alteration___Repair j ; Type of Project: New Addn Alteration .Repair i <br /> #of 'List of Fixtures "of List of Fixtures #of List of Fixtures #°f list of Fixtures , <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units j Heat PumpToilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping BoilerLavatory(Wash Basin) Drinking Fountain <br /> 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/Mop/etc.) Other: <br /> .SPRWNKLER/4VE§PIR.ESSION SYSTEM ' ' <br /> (Number 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 approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the work for which application Is made, <br /> and I comply with the State Contractors Law 1S.27RCWand 296.200A WAC. <br /> City of Everett Official Use Only <br /> .--.-..\—-0 0 PERKT# <br /> uthorized ent Signature Dafe (Revised 5/20/2015) • <br /> c3tarrat/J0. 9 g <br />