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F'ERIVIIT APPLICATION <br /> i <br /> .�. BUILDING i IVIECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION�T, <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)426-257-8810 1 FAX 425-257-8857 I(E)evereffeps@everettwa.gov I wwweverettwa,gov/permitss <br /> (04.3•®i b1a k IA Oftf.Pfe m) • : • .1PRQJ dT S0Th iINFO• •11/1,0 toI I • • <br /> n i <br /> PROJECT SITE ADDRESS: 1W e-- lv/1 A V PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r • ,.COMTACT lfit4Yl1=iii TIf®fit , . .• • • . . . , <br /> OWNER NAME: S'6._o [J'-4 ✓ kU TENANT NAME(If Commercial): <br /> OWNER'WAILING ADDRESS: aTREEr L(.r 69...A 0(5 Al i <br /> °m V 0-Ll`-11- STATE LO,/1 ZIP c9/C al f <br /> OWNER PHONE: • . — 'Z,Z-0`7 6 OWNER EMAIL: <br /> CONTRACTOR NAME: G v .6 DL) 6 ria-Te: f(Cer rt 2r C <br /> CONTRACTOR ADDRESS: STREET °�I��t)MIT <br /> PAC,l Pt- ck()Er . <br /> IT' .VMI STATE wk.- Zip 1C320/• <br /> CONTRACTOR PHONE: 49-5.-2-52->15(1- • 'CONTRACTOR EMAIL: geKt .e. SknGera_,L,o41 <br /> CONTRACTOR LICENSE#(REQUIRED): C 0a2.Pr j j&220— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): !]6 r "T• <br /> PRIMARY CONTACT: ❑OWNER f&CONTRACTOR HEI OTHER(Please Specify) w =_ <br /> CONTACT NAME: CONTACT PHONE: I 5--25-2.dF// <br /> Kt it-3 �./-L� CONTACTEMAIL: k,,¢h.L ;Q ss hi w<i.., �i 0 . <br /> .. :. :;•. .. BUJILDINGPtRIW1TAPP,LKCATXOtcT • • . . <br /> Existing Use of Building: I Contract Price of Work:$ I Z (70 0 <br /> Proposed Use of Building: Heat Source: 16as ►:Electric ElOther <br /> Building Type: ❑SFR Detached EISFR-Attached ElDupiex EIMultI-Family-#of Units: ElCommerctal E(lndustrial <br /> Type of Project: EiNew ElAdditlon ElRemodel ElRepair EIT.I. EISlgn ElSprinkler UDemolition EXChange of Use <br /> DESCRIPTION OF WORK: Add( A G +.0 ('(( S'/j r, 645 r o.7xu.1i ce Tost... tc4_ <br /> S�1,.461,,•G s,.,t i)�.` lees 1-4 Pe.ue.1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): _ <br /> l • ' :MVMcRAIWCAL P.ERtMlIT�A/ PPLIC TfORl . ' • . PLUMB6k4t0 PaRgilil APPLIIGATI®P9 <br /> X <br /> Type of Project: New Addn Alteration Repair 1 Type of Project: New Addn Alteration Repair <br /> #°f of <br /> List of Fixtures Fixtures I #re List of Fixtures I #°f List of FIxtures : #°f List of Fixtures <br /> Fixtures Fixtures , Fixtures <br /> [ NC-Air Handling Units ' 1 Heat PumpI Toilet - Backflow Preventer(Inside Bldg) I <br /> Forced Air Systems Unit Heater Bathtub Urinal l • <br /> Gas Piping Boiler i Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain i , <br /> (Gas Fireplace 7 Wood Stove Kitchen Sink&Disposal Grease Trap <br /> I Gas Range Ducting Dishwasher Roof Drains I <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 /> •EIiik ifgLE1 I I1•10P E.PMIO.1 S YATEM 1 1 <br /> Number of Heads <br /> CKNOWLEDGEMENT: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 /> urrent 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 /> ul/ding Official before being authorized under any circumstance.I am the owner,oil am authorized by the owner of this properly to perform the work for which application is made, <br /> and i comply with the State Contractors Law 18.27RCWand 290,200A WAC. <br /> Clly of Everett Official Use Only <br /> 1&...., S7 2_ - 1 ! M1o1 <br /> rner/Authorized Agent Signature Date (Revised 5/20 01 <br /> )/►h' <br />