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t. <br /> 1110 S <br /> PERMIT APPLICATION <br /> 'il4// 1 <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER I DEMOLITION • <br /> CI1Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425 257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everetfwa.gov/permits . <br /> (birde.or SLatclx Ink O.nt}{'.PieEse) • : • PROMO'S8Tk IINIF IUfA`TiO 'I • • • • <br /> PROJECT SiTE ADDRESS: AO ( Lai MLA IGL Lr"t 0 E 1 u (PROPERTY TAX 4: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . • ..COI1TAG1:Iklird TI1oINI . - • •• • • • • • • •• <br /> OWNER NAME: bo(J i`U li j }}''�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET' 6O/ �1 /�/(✓l�f(�"l j MLA • <br /> cnr (J1 z_err— (1 Yar STATE ZIP q V Z0 3 <br /> OWNER PHONE:..(.// Oi 5664; IOWNER EMAIL: . ,.„.ri., .....,, ... .�...n,..., ..,,_..-. .., rt .�.. <br /> CONTRACTOR NAME: E UOR.6 AJ 6B`0A-`�tt dc Glib-c- <br /> CONTRACTOR ADDRESS: sear 2-I` O k t Fit- AO gr • <br /> coy 'F:d Uai STATE (A..,A_. ZtP p�� • <br /> CONTRACTOR PHONE: 4`'5,-2c2..'f I4 • CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): E.0 ey2.6%p2,g,0 r t Y am' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): LI 6-1 4 55- • <br /> PRIMARY CONTACT: CI OWNER ONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 2 5-?. 2 de,/f 9 <br /> VE:d1/4_...) C Lc.) CONTACT EMAIL: e a V Sfl4 Lvo.L 0 ovt_ <br /> - ' • :•• " nU'ILEIIMQ PkRMIT APP.LICATlj®M " ' . . • ' • • <br /> • <br /> Existing Use of Building: I Contract Price of Work:$ i y't/ — iJ R F <br /> Proposed Use o_Building: Heat Source: ❑Gas 2, lectric QOther <br /> Building Type: /1t. :-1.- . h-• • F'-' .c -. ■'upiex ■ uitl-Family-4o I • ❑Commercial C7lndustrial <br /> Type of Project: EINew ❑Addition CIRemodel ❑Repair i .I. ❑Sign CfSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: T.,1 <br /> >b (.3) r�o1--)G 0 LDS. (4 T- PIA <br /> . <br /> lit)( bfi r 0 PI "-1 w 12 ot&Ket i- wry ° -er <br /> ASSOCIATED BUILDING PERMIT#(if a.plicable): <br /> $ -cii.AkICAL:Pt RM1T igip tCATIO 1 I . • • . PLWNI> if le P1 RIlti1 t APPLICATION _ • <br /> #of #of . #of #of <br /> List of.Fixtures ....._.. . List of Fixtures. List of Fixtures ._List ofFixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> ii. Handling <br /> Units Heat Pump Backflow Prevenfer{inside Bldg) <br /> o -. • - �UnitHeater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Sill Wafer Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Toilet <br /> -Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 11111 Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> :.61FiliKYKLEIV VE.9.PROM sYATEivif ' I <br /> Number of Heads M <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 tvith <br /> current federal,state,and focal taw.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.l am the owner,on 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 27 CI 29E 200A WAG. <br /> City of Everett Official Use Only <br /> JPER # 1 ot 07 00 <br /> . a ,_ ,,---(7 I <br /> )weer/Autii rfzed gent Si afn a Date (Revised 5/20/2016) <br /> 1/1 7—1 <br /> i <br /> 1 <br />