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I <br /> I <br /> l <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL 1 PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> .,�50Y,}t'a� �"g, (*, ,� �i .xp „S� x- Y � -r<.r ars P�Yt�3n r M1 �-a 3�}a ,��.� r- •'-�`+ <br /> �T� I _ a P.RO.fECTSIT_E7NFaR11ATIQN r4 �. _ :., -.> k <: n ny_` <br /> PROJECT SITE ADDRESS:r,1 88 S - S PROPERTY TAX#: Q�t! O L�b OGO CP 2-00 <br /> LEGAL for new construction: Short Plat/subdivision," ?--If—Lot No. 47Z(attach copy of long legal des(Yption) <br /> ,�+',=�r �w�'W'x',�'r��„�$ a'k .sem' a �.s-, ,.u. '4.' d '4r�t q.;.--.... .,.,,...--• S ', t i �� .� � 'W".. 7 a -�,� a5._<:i <br /> ---- <br /> - <br /> OWNER NAME: tl"' {LLlil4l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET' 9 Li `l �S i_54E� • q <br /> cnY r'-l/�,,!F7T__ STATE 4-( 11 ZIP <br /> OWNER PHONE: 4-Z-57- 77 3 OWNER EMAIL: AA/Q(, YFG/yR� RrrJG .L'O/f'j <br /> CONTRACTOR NAME: S <br /> CONTRACTOR ADDRESS: SMET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONT - W <br /> RACTOR OTHER(Please Specify) LL'i�­5I(� <br /> CONTACT NAME: CONTACT PHONE: I <br /> �ZS-Y'Zi- 2S[6 <br /> CONTACT EMAIL: J e] 'y1/llQ✓ nA <br /> saw - ,� r A.+,. 'ASK, a-+ 1g.,a.:...- .ypt.-.e r,;-.-•-�r-�'.. k L Yr Svf' - e '�+'�a '`' . ., ` irs �''x� .�.-.c'- .,"?'�' .BUIi:DING..�.�.. IAQp�..- Q QN ;�'`u 'r..w ` <br /> Existing Use of Building: �r�`✓� Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: VGas ❑Electric ❑Other f <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project ❑New Wddition ❑Remodel ❑Repair ©T.I. ❑Sign USprinkler ❑Demolition ❑Change of Use ! <br /> DESCRIPTION OF WORK-' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> � 1111EGHN_iG�PLPERMj<ZYArPPLICATI_O_N_h? ~ �P IJ_IV181HiG,'PFt_MiTcAiPLIGA'10N ; <br /> Type of Project: �Newy Addn _Alteration��Repair Type of Project New ^Addn Alteration Repair <br /> #of #of #of #of ? <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AiC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) 1 <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 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 Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medlcaf-Gas <br /> Range Hood Water Heater Other:Air) f-,,i- i <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> t <br /> s <br /> �"1C ii KEEW_SL1.PP.RESS10�1V <br /> IN umber of Heads <br /> ACKNOWLEDGEMENT.:i have reviewed this applicatfon 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 P <br /> Building Official before being authorized under any circumstance.1 am the owner,orl am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with a State Ciirit Law 98.27 RCWand 296 2oaA WAC <br /> City of Everett Official Use Only <br /> PERMIT# <br /> O erlAuthori rent Signature Date (Revised 10/92/2015) <br />