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PERMIT APPLICATIONBUILDING i MECHANICAL/PLUMBING 1 SIGN I SPRINKLER I DEMOLITION • <br /> (0;427CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 j(E)everetteps@everettwa.gov j www.everetfwa.govlpermifs . <br /> (Igluie-®w black ink On'y.please) • . P�OJCCT SITE i 91F®RYVIA`)i=1O11 • • • • , . <br /> _ <br /> PROJECT SITE ADDRESS: 2070 -9 l-I 7b„,5, Ne PROPERTY TAX#: 2,8652-7 Q 2.0Z-900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ONTAC INEOR IIII ISI®k�9 <br /> OWNER NAME: t 1 tZl '4 /O � 172N ' . TENANTppNAME(If commercial): ' Lfa/I/.U. <br /> OWNER!WAILING ADDRESS: STREET )8D194, ky� Park- &t refer !J 0 • <br /> 'L ^�cn j2.4L)d 1)6 STATE ea ZIP • 6{-z- <br /> OWNER PHONE: 'T'c' ' `3 7- `�®.,... OWNER EMAIL: ... ................. ..,...... ,,._,..,..,...,....._,..,... <br /> CONTRACTOR NAME: E UC., AJ 6 rtar cc Al . <br /> CONTRACTOR ADDRESS: STREET 2 (2-0 (ik cit. Au E <br /> • <br /> CO � (Y )alt5 1 STATE (kik_ ZIP iS2-0( <br /> CONTRACTOR PHONE: 4`15-2.c 2.'1-5(I4 • ICONTRACTOR EMAIL: iii...&�rr/✓10.JA £0._ <br /> CONTRACTOR LICENSE#(REQUIRED): COGY26.S&zt0.r !CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): f]6-7 q 5-5" 1. <br /> PRIMARY CONTACT: D OWNER CONTRACTOR D OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: 4 7 5-'2-5'2->//y" <br /> P4411/1" 1111 - EMAIL: <br /> fr� _ -- lel "At <br /> ��JIlL1 1Id�1� EZtilil`k APPL)f��`lii[®ti�1 <br /> Existing Use of Building: oFk. <br /> G.; i (Contract Price of Work:$ 1 20 '2 <br /> Proposed Use of Building: t O Heat Source: ❑Gas ❑Electric C[Other <br /> Building Type: ❑SFR Detached ❑SFR Attached C(Duplex DMulfi Family#of Units: XI-Commercial ❑Industrial <br /> Type of Project: ❑New )Addition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Rq„A-c-� Wal( iltem,05 ,L0 ..2.. Ng. ,w,k,.JJLL _ 0771-17-7 . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> : :114E-cai134ICAb EftIjt[I OPLI(O ti I® . • • . IPLUf1/.16ING i0Elkiltl1T APPLiiCATI®N <br /> Type of Project: _New i Addn AIteration Repair I Type of Project: New Addn Alteration Repair <br /> #of <br /> Fixtures List of Fixtures I Fixtures List of Fixtures Fixtures List of Fixtures I Figur s List of Fixtures <br /> A/C—Air Handling Units q 1 Heat Pump i Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems M 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 /> :•&PIR169KILIE k/41•PP6 EP�IO})t sy TlEiVI i <br /> Number of Heads <br /> ACKNOWLEDGEMENT.'/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 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 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> lQe9S”- 07 <br /> QthLd � ure Date (Revised 5/20/2010 <br />