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<br /> _, PERMIT APPLICATiON
<br /> BUILDING/MECHANICAL I PLUMBING 1 SIGN I SPRINKLER 1 DEMOLITION •
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)426-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everetfwa.gov/permits .
<br /> u<I [ ®.rn lhiat k Irak INN'.efea e) • : ' . RQJMT SUE IINFO. MATIoR :: .
<br /> PROJECT SITE ADDRESS: 1.,.520 t4 ev,Li•r Avim 'PROPERTY TAX#: I
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> , • : , .CONTACT IIPOR AT'iON . . . . • . . .. • • • • . •
<br /> OWNER NAME: 6./ (au.-„,--t-r- [)L`c.Ly..a.ina i !i .4(66,„TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET o. 7[ivy., 5;403 •
<br /> circ
<br /> "�`>Q . -1 STATE L , ZIP /Y2.1.°1
<br /> OWNER PHONE(Y2 ' zcf. gj IOWNEREMAIL:
<br /> .....• .. (/.L.,.,..... .. ._ ..., ,..... ..._.... ,,«, .,w
<br /> CONTRACTOR NAME: E UelkC3aMGV 6'm-rt.( fic 617 -c
<br /> CONTRACTOR ADDRESS: STREET 24'2.4, (A-c,tft-e- AUar •
<br /> err( .•GUM5IT STATE (A/AA- ZIP itagOf
<br /> CONTRACTOR PHONE: 4'2,5...2.5-2./5 r ILI • (CONTRACTOR EMAIL: K'�G i gnu a,,e07.4-1.--
<br /> CONTRACTOR
<br /> 7.4-1.
<br /> CONTRACTOR LICENSE#(REQUIRED): EL1 q5S®2.vra-r- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 6 4 -J-
<br /> ......-, .,-tom w,. . ..U+.o.,,»..,. »,......7......-n... ..-._».,...... v..�..,.-,.. ..�.�,. ....,...,.....». ..., ,.,., . .....,�»...»....
<br /> PRIMARY CONTACT: 0 OWNER aCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4 7.5»e.2.5-2.-,/,51
<br /> --- i 0 CONTACT EMAIL: We/4c a,»e 's'i» ez. 10 i,c i_
<br /> Existing Use of Building: !
<br /> Contract Price of Work:$ 41 .. i i
<br /> Proposed Use of Building: Heat Source: ritsa:s IIElectrlc ❑Other
<br /> Building Type: ❑SFR Detached ❑SFR-AttachedODupiex 17Mu[ti Famiiy of irCommercial °lndustriai
<br /> Type of Project: ❑New °Addition °Remodel °Repair EIT1. °Sign °Sprinkler °Demolition ElChange of Use
<br /> DESCRIPTION OP WORK: C1�- e-��c , �« (�} --It(Z k . . . .
<br /> ASSOCIATED BUILDING PERMIT#(if ap.11cablel:
<br /> • iMie i.ithmCAL PERMIT AEiPLICAT II®ki9 nuntjEI?.G PERMITAPPIUCATi®j-d •
<br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn _Alteration Repair
<br /> #°f List of Fixtures I #°f List of Fixtures °f List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> , A/C—Air Handling Units , Heat Pump Toilet I Backflow Preventer(Inside Sidg)
<br /> Forced Air Systems I Unit Heater Bathtub Urinal •
<br /> i Gas Piping i Boiler I Lavatory(Wash Basin) Drinking Fountain i
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting
<br /> - Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas I '
<br /> Range Hood Water Heater Other: 1
<br /> I Exhaust Fan Sink(Service/Bar/Mop/etc.), Other:
<br /> '. : :.e R Yt LER/EUPP.RESSIO SYSTEM . •
<br /> I I
<br /> dumber of Heads
<br /> 4 CKNOWLEDGEMEN7:i have reviewed this application and confirm the Information contained herein Is true and correct.Work done pursuant to this permitmusf comply with
<br /> :urrentfederal,state,and local law.The granting of permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized/n writing from the
<br /> 3uilding Official before being authorized under any circumstance.I am the owner,or/am authodzed by the owner of this property to perform the work for which application is made,
<br /> nd I comply with the State Contractors Law 18.27RCWand 296.200A WAC.
<br /> ..,------ City of Everett Official Use Only
<br /> Zo) 1— s— /I i PE11)11 #1qOI _... es I Li.
<br /> caner/Authorized Agent Signature Date (Revised 6/20/2018) _
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