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. 1 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION • <br /> 04enr CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits . <br /> (BLtie-OE bfack fik.onj3i.etease!) ., : ' pRivE6T SII.Tt Ili FOilliA`PIO • •- • . <br /> PROJECT SITE ADDRESS: 3620 tie !PROPERTY TAX#: 0007 5- Z.2.A° <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> . <br /> OWNER NAME: 6 Q10142MISti e.bt Ttd TENANT NAME(If Commercial): 1406 M15 it Co. 41Acit..Parr <br /> OWNER MAILING ADDRESS: STREET '3O tom. <br /> CRY i,t)-titeitt STATETA �1- ZIP 9f,Zpl <br /> OWNER PHONE: `t 2.c -740,.4• ?6 .,.... OWNER EMAIL:,.Ji4 Q .✓,' d tl-�rpu(�........... .. <br /> CONTRACTOR NAME: E U .G DLJ 6`�`r t"�� �tittC Z-'0t -,.,..r,. <br /> CONTRACTOR ADDRESS: STREET '24 2 /� P 1 c A()or • <br /> p� <br /> CITY 0 U t2-t 6 1 STATE V/4- ZIP I Z7', O( <br /> CONTRACTOR PHONE: 4'2,5'.9..5-2.-3//14 . !CONTRACTOR EMAIL: Plea&6e) % 44 '4 • C...0 tn, <br /> CONTRACTOR LICENSE#(REQUIRED): EU SSS a>2.z,c) !CITY of EVERETT BUSINESS LICENSE#(REQUIRED): CI 6-1 ae !• <br /> PRIMARY CONTACT: 0 OWNER i CONTRACTOR 0 OTHER(Please Specify) - <br /> CONTACT NAME:ICONTACT PHONE: 4 ..X5 ,l f9 <br /> 2 d, c <br /> • <br /> AW, L P - - CONTACT EMAIL: 14wZ ,e,-,- �=> G JS ai a <br /> . RUi L> II?Ic PERMIT APP)r►CATION - : • . : 7 - <br /> Existing Use of Building: No 6cti—0 PPE,a Contract Price of� J�.IWork:$ . 50,�bf� <br /> p <br /> Pro osed Use of Building: "Q C} �j°6 Heat Source: l�1Gas Electric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached CDDuplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New IJAddition DRemodef GRepair ❑T.I. OSign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: (2.„., <br /> � uta- 4,,.i,C 5 3^-fp.J (L C/Lt,L�) (3 5 tte-)(Lc)i'(n- tMAIS `5i <br /> (3 )J �Qey ,u dAcal,_) 2- 0tp- t c.0.0t-toet ' t,jp M - w a+,P rs caul- Worr 1Ced <br /> ASSOCIATED BUILDING PERMIT (if applicable): <br /> • <br /> : .AliECR.AlinCAL PEkli/I1TAOPLIRO.x I®M . • • . PLUM i INC OEMit APPILICA IO! - <br /> Type of Project: New Addn Alteration 1l'Repair j Type of Project: New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fier s List of Fixtures <br /> A/C—Air Handling Units Heat PumpToilet —Backflow Preventer(Inside Bldg) <br /> `L Forced Air Systems Unit Heater Bathtub j Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower _—Floor Drain i • <br /> Gas Fireplace _ Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains - <br /> Clothes Dryer Hookups Other: Clothes Washer <br /> Range Hood 'Water Heater . Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.), Medical Gas <br /> Other: • <br /> I 'Number of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true end 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 underany circumstance.lam the owner,ort 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 /> 64I9i PERMIT M 1gvco-o�lg <br /> .avrreW/Authorized gent Signature Date (Revised 5/20/2010 • qz) <br />