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PERMIT APPLICATION
<br /> "111°.0440BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> 5g0b sv,, 4 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision
<br /> Lot No. (attach copy of long legal description)
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<br /> IPfi `� dtfW MMVS CONTA tits. f0*ATION . z ., _ . .,.E� �`�.g
<br /> OWNER NAME:U/ '6; 6 ,ezoo z-S ANT NAME(If Commercial):iOE /C
<br /> OWNER MAILING ADDRESS: STREET -9;2/0 /3Z 1
<br /> 4 —OWNcITY EVZ/& STATE,J ZIP 941,5—
<br /> OWNER
<br /> ER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: ,4 - 7, 07/ /�
<br /> CONTRACTOR ADDRESS: STREET e/e,f�J /) �!`' (//�Jgam/
<br /> CITY ��F//f / G.O STATE 01V ZIP / 2f 5
<br /> CONTRACTOR PHONE: ,0; T' Y CONTRACTOR EMAIL: ,-®�, �- y�'/ ,��fZ
<br /> CONTRACTOR LICENSE#(REQUIRED): i�N(/a*900 LR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 049 g 7 Sj
<br /> PRIMARY CONTACT: 0 OWNER ISI CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: g v„?C. ,523"
<br /> .1)1411 -1119/4CONTACT EMAI / ' E)! t a
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<br /> Existing Use of Building: C 4,,Contract Price of Work:$704/7),5:00
<br /> Proposed Use of Building: j 7,4, /ex/ff� Heat Source: ❑Gas DElectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Mndustrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.l. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> .a#9,14///AO % W /teq.e/ c ,9i,v) Tae/
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):,i0/37/
<br /> fi4i40+ANIGa6100IVIf" 10100ATION M , , :ZER O PLl1MBING PERM: APPL[CATION5 Fath ;
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> ,x SR RINCLttaSItR.PY,,RESSON SY$' EM x
<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 /> 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 0 • 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 I c. ply w h the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> I.. fc;�/5 (11 2''010
<br /> Owner uthorized Agdfit Signature Date (Revised 10�2TZ01
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