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<br /> WM PERMIT APPLICATIO
<br /> BUILDING/MECHANICAL I PLUMBING !SIGN!SPRINKLER! DEMOLITION
<br /> EVERETTCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257"8857 I(E)everettepseverettwa.gov 1 www.everettwa,govlpermits
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<br /> PROJECT SITE ADDRESS: / f °' A tit g ° " ' PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivsian Lot No. (attach copy of long legal description) ,
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<br /> OWNER NAME: "Clic merife Cc TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING'ADDRESS:. STREET 5 f 16. ,°
<br /> CITY t itit,C tY'‹^ktSTATEZIP a(8 cg
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: . "t D ,r°t$ `X prleoz,,i pki/` &Ns Lc
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<br /> CONTRACTOR ADDRESS: STREET i q 31 if' 1,`ice+ 2 I 1
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<br /> CITY I a " 6y stkre 03 A TIP 'et tat 01
<br /> CONTRACTOR PHONE: j 77-3-01-4‘i CONTRACTOR EMAIL: OAS r-r s ,, <c-, t
<br /> CONTRACTOR LICENSE#(REOUIRED): X p a.e1-"63 S 3 c.ti CITY OF EVERETT BUSINESS LICENSE#(REQUI'ED):
<br /> PRIMARY CONTACT: Cf OWNER R 1 ,CONTRACTOR 0 OTHER(Please Specify) i
<br /> CONTACT NAME: „_' "„„, r P. CONTACT PHONE: 3--0 2-0
<br /> CONTACT EMAIL: 6-- 4, x I
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<br /> Existing Use of Building: Contract Price of Work:$ 9 07 ,42,0
<br /> Proposed Use of uildinq .,ict.e.,1 4401 I Heat Source; Maas 0JElectric DOther
<br /> BUILDING USE: WFR °Townhouse DDuplex DADU °Multi-Family-#Units:,, ©Commercial ©Accessory Stiucture
<br /> Type of Project; C New DAdd tion ©Remodel CIRepair °T.i. OSign COSprinkler ODemolition OChange of Use!
<br /> DESCRIPTION OF WORK: ..g,ep tploj k / / / i5"
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<br /> ASSOCIATED BUILDING PERMIT# if a••licable;:
<br /> '''"A7140411—" .,:,.. `Ii�I A1301S, > . a, el X44. Ap uiO4y1 04..
<br /> Fixture List of Fixturesure List of Fixtures r=ixture List of Fixtures Fixture List of F7xtures
<br /> Count COMM Count Count
<br /> A/C-»Air Handling Units Gas Piping 'Backflow Preventer(Inside Bldg ' - Shower,Tub,or Combo_
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-tom•,pret,tloor)
<br /> Clothes Dryer Heat Pump&Ductless 1 Dishwasher • Sink-Residential(kltc en,bath,bar)
<br /> ibuot System(Remodel) - Refrigeration Drinking Fountain Sink-Utility,laundry,rnop
<br /> ,Exhaust Fans(Residential) • Commercial Ventilatior Floor Drain ; 3 Toilet i
<br /> Exhaust Hood{Type i) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping epair
<br /> `Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains 1 1Water Heater
<br /> '._ ;„ 40 0 W1PPtt#01**0/11 . .iSewage Ejector or Sump Pump Other: ,
<br /> Water Suppression System No,of Heads
<br /> Chemical Suppression System No,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./am the owner,ori am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Oary
<br /> 11 PEV #
<br /> Owner/Authorized Age Signature Date (Revised 4f15f2f)19)
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