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041‘77. PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits . <br /> (B_ uie'o r Block kik Only_Please .P <br /> • - R'JEC SITE INFO.kiviATKOfl • •• . <br /> PROJECT SITE ADDRESS: 04.Z I-I) , f PROPERTY TAX#: Di/DEMOC W IOIOD <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> OWNER NAME: L6$ L..449ei m-50 e 1(79 TENANT NAME(If Commercial): • <br /> OWNER MAILING ADDRESS: STREET L(SOO2 14-0yt 5tE IO 0 Q • <br /> city 6. L`tU`T STATE wA ZIP L gj ZV i <br /> OWNER PHONE: OWNER EMAIL: <br /> __.E ., <br /> ....,. , �afIC'er42i ' .., .t......... ... .. <br /> ..........,., ,,. ,w. <br /> ,,.._, ... .. ..... . .. . ... <br /> CONTRACTOR NAME: U-ld.� � 6ra-T�C <br /> CONTRACTOR ADDRESS: STREET 2I 2-0 ' 1 ACJ Ir , <br /> CITY ellairri STATE WA-- zip /S20( <br /> CONTRACTOR PHONE: 14`-5f`-5 2>1'6 f/4 • CONTRACTOR EMAIL: M OiO&Se, ,L1 v4. CdwN <br /> CONTRACTOR LICENSE#(REQUIRED): EVC;122(..�j'�p'�•.2,0-r- ): 41.3' tCITY OF EVERETT BUSINESS LICENSE#(REQUIREDa 6.7 ey,5-5' <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NA : CONTACT PHONE: 142 S--2_5-2.,,,r/9 <br /> A( ,„ CONTACT EMAIL: fiAktid @gyi►7uq . <br /> BUIL DMG PERMIT APPLICATION ' . - . . • . <br /> Existing Use of Building: L4'47 —do p M411( 6j� Contract Price# of Work:$ !S,Coy O <br /> Pro osed Use of Building: i' r Heat Source: ❑Gas I&Electric DOther <br /> Building Type: ❑SFR Detached ❑SFR Attached ❑Duplex ❑Multi Family of Units: gCommercial ❑Industrial <br /> Type of Project: ❑New DAddition EiRemodel IgRepair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: rzeit,itnie tI/v(4 c-x(h'tt 4.4 5pct.T i{ (.1,4 (4,7.5,7„6- k,14 Loco-Tunic),CIVAci I <br /> 407 Wu&ter , rll,eu tfACI011 U�1,1' w/ yMvpd+# / 1948 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> : .ffi1ECi .ilidICAL PERI1(IIT APPLICATION 1 . . . PU9111 0INO PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration s Repair 1' Type of Project: _New Addn Alteration Repair I <br /> #of List of Fixtures /of List of Fixtures °f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units i Heat Pump ; Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater i Bathtub Urinal <br /> Gas Piping Boiler Lavatory(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 /> 'ariliV,KL.E1 /4 PPnio. I®N SYSTEM . . I <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.lam the owner,or i 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 18.27 RCW and 296:200A WAC. <br /> City of Everett Official Use Only <br /> I PERMl7 <br /> c)(7. -------" ti/i//Y 0 OL\—to\ (0 <br /> @9PR2r/Authorized Agent Signature Date (Revised 5/20/208) <br />