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• <br /> • <br /> PERMIT APPLICATION <br /> 11)114/.. lidilr;- -- : `f- BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> "::-TIT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetfeps@everetfwa.gov I www.everettwa.gov/permits . <br /> (blue-®w biaik ink®.lho[eake) - ' • pRQJE©T.IlTI INP©,G IlliATIeN • ••- <br /> PROJECT SITE ADDRESS: 94'O Ji to PROPERTY TAX#: c 993 o ZCb?Oa 74d <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> . <br /> : .. • c,g klTAe .liviF®fi.If1r Arum •. . • <br /> OWNER NAME: / /€-tW5 MA44jLC9 (( /�// yTENANT Al (If Commercial): <br /> • <br /> OWNER MAILING ADDRESS: STREET /�ei��g`_ i l/ /t-hUA) Al �(/ ,5/n <br /> 1 j� .5/'f I/ STALE IA 4 ZIP 93 ` <br /> CT! (fI/ L"!!�� <br /> OWNER EMAIL: <br /> 'CONTRACTOR NAME: E U .6MA,...) 67-4-T(C e' 02 - <br /> CONTRACTORADDRESS: STREET 2I �i`J ) eAci. AU gr . <br /> mT' F:d v evi 6 { STATE �.(T ZIP Ct C320/ <br /> CONTRACTOR PHONE: 4`2-5,2-e 2••'�(ie.4 • CONTRACTOR EMAIL: & c.,55f'tW64 1 C <br /> , <br /> CONTRACTOR LICENSE#(REQUIRED): (, 5S€72.o r iciTY OF EVERETTBUSiNESS LICENSE#(REQUIRED): 4.3 6-Z q,-5 I• <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR Et OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 7 5 a 24-2>`zj10 <br /> VA ?;4". i y CONTACT EMAIL: tv1,Nr(( qcM.a-dt-,(-A" <br /> �(I) j lk�Ga Contract Price of Work:$ � D <br /> Existing Use of Building: ( C I <br /> Proposed Use of Building: Jv'0 Cl.(.,4,�Cac Heat Source: �GaS C[Electric ❑Other <br /> Building Type: CISFR Detached DSFR Attached DOuplex C]Multi Family#of Units: ®Commercial ❑industrial <br /> Type of Project: ❑New DAddition DRemodel C}Repair ❑T.1. ❑Sign ❑Sprinkler flDemolition DChange of Use <br /> DESCRIPTION OF WORK: R Lo f� d 4 3 A� // O <br /> cry,4.W etas . vV 116 tit/te A.�A&6I o(e' v; biro . 5 ^-e- tt E e4 <br /> • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .ivi) C AI•NICAL 0EkliaT Aopud-AT im I I . - • . P+LUIVIliltie 0Ell IirtlT APPLI(cA T l®N <br /> Type of Project: _New Addn Alteration Repair I <br /> ) Type of Project: _New Addn Alteration Repair <br /> Lisf of Fiures List of Fiures I 'of List of Fixtures i #°f List of Fixtures <br /> Fixtures Fixtures I Fixtures Fixtures <br /> i 3 NO—Air Handling Units Heat Pump Toilet Back-flow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler I 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 11111.1 Dishwasher Roof Drains • <br /> I Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.)II <br /> Other: <br /> i . :' ,01111 IKLIER/,01I1 4 SSli.N SYSTEWA . : <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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 most 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 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 /> /1 IPEkT ��Oc 051...„ I <br /> -erarrerfAuthor' gent Signature Date (Revised 5/20/2016) _ <br />