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PERMIT APPLICATION <br /> $411111PBUILDING/MECHANICAL/PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps©everettwa.gov www.everettwa.gov/permits <br /> e::o;:: cic::I ,:::Onl >`:: _:: .,O ;>;:;<s_;><:' :P O <br /> e <br /> �t�� _ ;;Sly :: : :o <br /> �........................._...: .>Rt1�c. �y':Mai...�..... . . :.,.I* . ...�'t'. . N*.:::...�.. RlYtA .::._._ ..:..:..:: .;: :::::: : ::.:::. <br /> PROJECT SITE ADDRESS: Z-11 Uc✓✓vt t ( D Cc ?2H2 J•4J VOI PROPERTY TAX#: 31 7L Z 3C700gQ() <br /> LEGAL for new construction: Short Plat/subdivisionI3! 'd 4l L t(j7 S /5+-Lot No.63/'7 (attach copy of long legal description) <br /> OWNER NAME: ✓USC.-. OfV/a° /l� c,174-,p 7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET/7.]7 [ i 1�eJ?- Ave_ g 7 <br /> cnv t�GrG��' STATE 61,44 ZP'en()] <br /> OWNER PHONE: LZ`5-34f1,--f -,��7,C�'�f OWNER EMAIL: So1-�fpl�Z�i e:/!/L°i. Gam". <br /> CONTRACTOR NAME: r...),e;i.„r' <br /> CONTRACTOR ADDRESS: STREET <br /> cm, STATE ZP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR RI OTHER(Please Specify) y6 - <br /> CONTACT NAME:� �� y CONTACT PHONE: / - k2 Z-fl I <br /> CONTACT EMAIL: cors <br /> Existing Use of Building: g6 id.>r.�ir I Contract Price of Work:$ sta." e/i' _ I Ifhp kn ie) <br /> Proposed Use of Building:7c5rc(r71, t„\ Heat Source: ❑Gas ($Electric ❑Other <br /> Building Type: ®SFR-Detached CI SFR-Attached CI Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: CI New raAddition ®Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:1�, rhr r 'del .- GAA- c--_ , ,7(17S-4-1nF/ SFR. 4..). 1 1-/i.SS f Go•e S/S*e <br /> /USW cvn.c/'�C� re.t-io itis • ip, <br /> 4 - c, roc'n'� i+t'c <br /> 000 4,":91a.4)) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 1 . '. .. <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 /> A/C-Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> - Forced Air Systems Unit Heater 1• Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove J 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 FanI Sink(Service/Bar/Mop/etc.) Other: <br /> ........................................................................................................................... <br /> .::::::::::::::............................................................................................................. <br /> 'Chemical or Water I INo.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 wilting from the <br /> Building Official before being authorized under any circumstance.lam 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 /> PERMIT# <br /> 0„,;( g 0 tve?, <br /> OwneriAdtihorized Agent Signature Date (Revised 9/23/2016) L� <br />