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0 • <br /> • PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN I SPRINKLER/DEMOLITION • <br /> ' • CI tY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> �M� (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I Www.everettwa:gov/permits . <br /> (Blue'®/Wee •='ely,lk k i tes®) ' : ' PROM Off'Skit FO. iUWA`if(Of�'! <br /> PROJECT SITE ADDRESS: IND ka O/z7 1 14 <br /> PROPERTY TAX <br /> ##: t.`e c/3 3 ocv / 33<'d <br /> LEGAL for new construction: Short Plat/subdivision No. (attach copy of long legal description) <br /> 'OWNER NAME: itiaa.mew- P-Li- 7 ie,TENANT NAME(If Commercial): (ul'l{-fica,,ft'rfi''/! <br /> OWNER MAILING ADDRESS: sillier '7/i o V tie- e--€,t) 14.1 fiei ''')i f` A • <br /> CITY o tl ii) f STATE 04 ZIP 98 24) <br /> OWNER PHONE: �,.�, OWNER.EMAIL: <br /> CONTRACTOR NAME:mm E Ul. v�c�1�n.0 A 6 ri r: ec kt4, <br /> CONTRACTOR ADDRESS: STREET `2I'2.-D/� �qP 104 Ue- A • , , <br /> cirr - UMM 1 STATE (jt,J.K— ZIP Qp632-0/ <br /> CONTRACTOR PHONE: it`2-5.-2- 1..1.5I 1(.4 . CONTRACTOR EMAIL: molt,t, a _yfikiet'tt e£`vvi <br /> .,& <br /> ) E(, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C.)6-x ,5-5" • <br /> CONTRACTOR LICENSE#(REQUIRED:. t� °aS 1�2�0`� <br /> PRIMARY CONTACT: ElOWNER IEI.CONTRACTOR p OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1475-.j�2,d,//9 <br /> CONTACT EMAIL: LYIB' 44. Cy �, 5,1 al-4 <br /> • iv:lib:SR 'IE fITAPPf.ICAT>(ON . <br /> Existing Use of Building: 7Jt) e 6'ie 1 Contract Price of Work:$ <br /> Proposed Use of Building; �`�O L <br /> Heat Source: [ Gas 1 Elecfrlc 170ther <br /> Building Type: [ISFR Detached C(SFR Attached []Duplex ❑Multi Family#x of Units: IKfCommerctal [(Industrial <br /> Type of Project: ❑New ❑Addition [(Remodel kRepair [IT.i. [(Sign ❑Sprinkler ❑Demolition [(Change of Use <br /> DESCRIPTION OF WORK: d'P'6 A 0 fJ(:i G to i'rj k `04,"rI 2 -07,k. <br /> li <br /> ASSOCIATED BUILDING PERMIT 1/(if applicable): <br /> ,1V1EeufilRHCAl,PERM T•. kipueATIO . . • • . IPILDIVI6ING 01ERfiflIT APPH 9CATI(®N • <br /> Type of Project: New Addn Alteration /(;Repair 1 Type of Project: New Addn Alteration Repair <br /> #of #of Fixtures List of #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List ofFixtures Fixtures Fixtures <br /> ( NC—Afr Handling Units M Heat Pump i Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Urinal <br /> Gfriass <br /> Gas Piping Boller Lavatory(Wash Basin) Drinking <br /> Water Heater Refrigeration Shower Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal = <br /> • <br /> Gas Range - Ducting Dishwasher ''�'■ - <br /> Trap <br /> Clothes Dryer Hookups Other: Clothes Washer -' <br /> Range Hood Water Heater Other:ExhaustFan Sink(Service/Bar/Mop/etc.); • - <br /> .•&irn$X( EGA/SUPPI EPY®N9 SyyTE»I , ' ; 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.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/comply with the State Contractors Law 18.27RCW and 296..200A WAC. City of Everett Official Use Only <br /> j <br /> IPER <br /> it <br /> er uthorized ent Signature Date (Revised 5/20/2016) •`/2_ <br />