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PERMIT APPLICATION■ <br /> "j"-A BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (BI4t or ill* 1n In ..PI' a , RAJ tsITEW MA :10 �hglNu <br /> PROJECT SITE ADDRESS: /1-7 23 Z ' t i- 5 PROPERTY TAX#: e 7 2? C7ocx�5�O <br /> LEGAL for new construction: Short Plat/subdivision AINdeZzAL LAN/e.Lot No.52- (attach copy of long legal description) <br /> OWNER NAME: tomb e' &eye"-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /r)1.3 k2.-3 " SES <br /> cm( Ei iw STATE V v A ZIP 9S7--44 <br /> OWNER PHONE: q14-°- 35 S-- I t n'L OWNER EMAIL: <br /> CONTRACTOR NAME: ctififI.� ,lL1 /t/E54.40/ SE.Adil-A-5) <br /> CONTRACTOR ADDRESS: STREET 9.•.2.041 l32 " SD r to./ y� <br /> CITY ✓o{C7�1/� STATE WA ZIP P b <br /> CONTRACTOR PHONE: L11-5—'/g'/ —44Cp1,'o CONTRACTOR EMAIL: SGtA) JF-4 A164— oy 2-a-- Atriv-l:14'1• <br /> CONTRACTOR LICENSE#(REQUIRED): gikA1-0A E'5 (oil'', CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): :1 2-- <br /> PRIMARY CONTACT: ❑OWNER gCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: �� E.L CONTACT PHONE: 412-4—tart <br /> akf <br /> CONTACT EMAIL: Svj jtAA/e; Af k,,9/1„.e...A4S.,/.COM, <br /> P s a <br /> ...- , ;$ Fu��ti � �4". .. b� ., .x . BU11 DiN4PERMI"1„,07,6I A''101! & 'y <br /> Existing Use of Building: Contract Price of Work:$ 314e-1 <br /> Proposed Use of Building: cel--t1.-- Heat Source: $ as 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached PS.FbFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition psuemodel ❑Repair ❑T.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> //vim L.L-/a1 1.• A. Al &A S F14-F— —r4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> '. :' '„ I I*ANC .i 20011 P ICA 7:0N '. " E a2;11 _.71LUMBING4 PE M 1401 I A "IO:N1M .^ __' <br /> Type of Project: _New -Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Q <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 /> '° "RRRIN 4010 0:00Nf$810.,.w IM <br /> Chemical or Water 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.I am the owner,or I 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 /> Owner/Auth•rized • .e t Signature Date (Revised 9/23/2016) <br />