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PERMIT APPLICATION <br /> r BUILDING I MECHANICAL I PLUMBING/SIGN /SPRINKLER i DEMOLITION <br /> 7' CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everelteps@everettwa.gov everettwa.gov i www.everetlwa.gov/permits <br /> PROJECT SITE ADDRESS: .13 19 ,toC ave bylvQ V''` , ` `°d * .Ckt3 PROPERTY TAX#: O,.3 I ! 1 o <br /> LEGAL for new construction: Short Ptatfsubdivis&on Lot No. (attach copy of long legal description) <br /> r ^+ e,.,,, ,r'., t,r., s.... s,t .. t..�-- '-'-' , l��as.-�_ ;:,„ `� <br /> OWNER NAME: C COV}'}I^{ C: •i"' TENANT NAME(HCemmerctal): <br /> OWNER MAILING ADDRESS: STREET .SSS i 1 el‘,4,!.., <br /> , <br /> CITY l''' WM _.. :STA'Pk ( ZIP `.Z <br /> OWNER PHONE: ! vj ' OWNER EMAIL: JQ Y}($G iiirokoefo(w.a <A o i .tU <br /> �1 <br /> CONTRACTOR NAME: P r (.00 1 Xr i" 1 V 0 4 IA f, <br /> CONTRACTOR ADDRESS: STREET Z D DO mc W +k Coil <br /> etrx r+J L SIAM A, a re i )1/'' <br /> CONTRACTOR PHONE CONTRACTOR EMAIL: 4I Di'ta'f}1(t +S 0s :. ' rS''e-64 'C 001 <br /> CONTRACTOR LICENSE#(REWUIRED) R i,(1 V - CITY OF EVERETT BUSINESS LICENSE*REWIRED): i O <br /> PRIMARY CONTACT: ❑OWNER NI CONTRACTOR 0 OTHER(Please Specify) _ �. . <br /> , <br /> CONTACT NAME: <br /> CONTACT PHONE: .(9 r `� _ ( ,5c.,,(j <br /> J0nG GA/1 s(-OH <br /> �M <br /> CONTACT EMAIL: J e -4 e„x ^ r 00 Q.(f v. Ci . L..0 WY\ <br /> .•.w„ -.€ ;, ,;Yi : Kir; 211:771:111,r,:q717-Erlr, z ,: eta <br /> Existing Use of Build Contract Price of Work:$ T.*-t': 4'.-0`. <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Whirling Type: ❑SFR-Detached I:SFR-Attached ❑Duplex ❑Multi-Family-41of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition I:Remodel ❑Repair ❑T.I. Sign ❑Sprinkler ODemolition ❑ han,.e of Use <br /> DESCRIPTION OF WORK <br /> w+0 -er d rrat R I t t,-e s fn r -ecI f e J fl x- )reg , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): if I <br /> e �z � <br /> T <br /> YP of Pro 1ect: NewAddn Alteration _Repair Type of Protect: New Addn Alteration _Repair. <br /> #of for <br /> Fixtures List of Fixtures List of Fixtures ft of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units , /;Heat Pump .Toilet — Backflow Preventer(Inside Bldg) <br /> Forced Air Systems "Unit Heater i Bathtub -- Urinal <br /> Gas Piping r Boiler j Lavatory(Wash Basin) 'Drinking Fountain <br /> Water Heater Refrigeration 1 Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal— Grease Trap <br /> e Ran Gas <br /> .--_ g Ducting 'Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 'Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mop/etc, Other: <br /> Chemical or Water No.of Heads <br /> 'ACKNOyEDGEMENT::i have reviewed this application and confirm the information contained herein is true end correct Work done pursuant to This permitmust comply with <br /> current f8derei,state,and local ma - fly of a permit only authorizes approved work end no deviations therefrom.Deviations must first'be authorized imn writing from the <br /> 8u#rfir g OItiplal before being r: <br />