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425-252-1666 c,m,heating 09:32:13 01-20-2016 7119
<br /> Oren- PERMIT APPLICATION
<br /> BUILDING /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©evereltwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: f 1 6 -Rik() - tj 7 t4 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Piat/subdivision Il Lot No. (attach copy of long legal description)
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<br /> OWNER NAME.1�'I
<br /> Order"1 1 TENANT NAME(If Commercial): t CA e l.e S
<br /> OWNER MAILING ADDRESS: smear la 14� �vtJr'�.L.1b# Dv"/
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<br /> OWNER PHONE: gals - act-34'410 OWNER EMAiL:
<br /> CONTRACTOR NAME: Cal fAvo n;JJ I no
<br /> STREETCONTRACTOR ADDRESS: STREET 11115- Uroad wad a
<br /> CITY I...Yfrett STATE WA y,, ZIP -(B 240 I
<br /> CONTRACTOR PHONE: Li 2.5 2459 (p&Grp CONTRACTOR EMAIL:debt a �CIvillte(2 ivi9. COWL
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<br /> CONTRACTOR LICENSE#(REQUIRED): cri N EA S Oci5RLi ICITY OF EVERETT BUSINESS!_ICENSE#(REQUIRED): 0 I(p g
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<br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACTj� NAME: 'Q, q CONTACT PHONE: 1425 259 66,6, ,
<br /> Debbie t C a Ve rs CONTACT EMAIL: de jp pie & Collet a al . call
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<br /> Existing Use of Building: Contract Price of Work:$ :I o I to . 00
<br /> _Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: , '0Commerclai IJindustrtal
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.1. -❑Sign - ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Project: ,_New_ Addn _Alteration __Repair Type of Project: New Addn Alteration ,Repair
<br /> f7xtures List of Fixtures Flus List of Fixtures Flx#iur s List of Fixtures
<br /> Fixtures List of Fixtures
<br /> A1C—Air Handling Units I Heat Pump Toilet - Backfiow 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:
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<br /> ACKNOWLEDGEMENT:i have reviewed this application and confirm the Information contained herein Is hue 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 Official before being authorized under any circumstance.lam the owner,or I 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..2001A WAC.
<br /> City of Everett Official Use Only •
<br /> PERMIT#�/
<br /> pevistioc, .ou,h, i/A0 �/!� yL ( �oitf /
<br /> ner/Authorized A t Signature � Date (Revised 1 1211015)
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