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• 6 <br /> • <br /> PERMIT APPLICATION <br /> BUILDING I iiiIECHANICAL I PLUMBING I SIGN i SPRINKLER I DEMOLITION - <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I wwweverettwa.gov/permits <br /> 0§:11je-or back Ink©nf y-> lease) • - - PROJECT SITE INFORIWATIO 4 • •• • - <br /> 'PROJECT SiTE ADDRESS: q612 J J' As- 40' (PROPERTY TAX#:6/0 534.049e /0 Wiz' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of Fong legal description) <br /> CrA 4i7TAC IiNFORll1i1A t©©N • •. . . • . ... • • • • <br /> OWNER NAME: 6° 5 / 9'k Zt✓G TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (ON l0 /r / - /( ybl./ , 9I <br /> ciTr t4s1/07✓ STATE If°�' > / ZIP 8 96* <br /> Z,j- <br /> OWNER PHONE: (S�_ 1, 2- ,OWNER EMAIL: At 5l a hef.b 5„AAi `Cit4A-k._ .,.Y... .... <br /> 'CONTRACTOR NAME: E UOR.6 AJ `.t` T-a e 0' - <br /> er <br /> CONTRACTOR ADDRESS: STREET `2I 2-0/� � . iv.)CITY F:d UCV/ q 1 STATE (iv ZIP 6t 2,20l <br /> CONTRACTOR PHONE: 4-2-50-ric2-'f5/1( - ICONTRACTOR EMAIL: V,''&L t ,14•V`A L ' <br /> CONTRACTOR LICENSE#(REQUIRED): EVer26.5s®2•2,0-r' CITY OF EVERETT BUSINESS LICENSE (REQUIRED): 6-7 s- I. <br /> PRIMARY CONTACT: ❑OWNER L CONTRACTOR El OTHER(Please Specify) - <br /> CONTACT NAME: CONTACT PHONE: 47 5e.24-2 d,/f <br /> K ,- ()Alike- CONTACT EMAIL: kAvt C c.S`;3Mw/ ,6-4-`. <br /> Existing Use of Building: • '0 C1 ' 1 Contract Price of Work:$ /*E <br /> 06) <br /> Proposed Use of Building: at (AA i kthe- Heat Source: EIGas NElectric ElOther <br /> Building Type: ❑SFR-Detached EISFR-Attached DDuplex ❑Multi-Family-#of Units: KICommercial fllndustrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair DT.I. EOSign ClSprinkler EDemolition DChan e of Use <br /> DESCRIPTION OF WORK: /Z1= ✓J,I6 t nI /u Pr()0' - , 5pyLU2 l b cA-7t oi,o, e� 0 Gvt 9 4, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> fv.fici; ANl1OA,;O QtkiialT AOP tud T I®18 • P�IAIVI) I �� >f Illfiil u�PPIL9��T I®d <br /> Type of Project: New Addn Alteration Repair I Type of Project: _New Addn Alteration Repair <br /> °f List of Fixtures I :,-°r I List of Fixtures 1 #°f i ■ List of Fixtures <br /> Fixtures Fixtures j Fixtures Fixtures <br /> A/C-AirHandlingUnits / Heat Pump - • <br /> '" Bldg) <br /> Forced Air Systems Unit Heater ) ■ Urinal <br /> Gas Piping Boiler I - ■ • <br /> Water Heater Refrigeration • - •■ Drain <br /> Gas Fireplace Wood StoveDisposal - -• <br /> Gas Range iDucfing - I Roof I - <br /> Clothes Dryer Hookups Other: j Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> i <br /> •ePI l 9(L1R I ,YPPREPM itA9 SY T1=1 I - <br /> !Number 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 /> :urrent 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 /> 3uilding Official before being authorized under any circumstance.lam the owner,or l am authorized by the owner of this properly to perform the work for which application is made, <br /> inc I comply with the State Contractors Law 18.27RCW and 296:200A WAG. <br /> City of Everett Official Use Only <br /> _ (? PERM-I r A /) n <br /> `� ®' �lC��ti'� }VIA/ � ('C�I(2i--D . <br /> wner/Authbrized A t Signature Date (Revised 5/20/201&) - <br />