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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION
<br /> "11110414, g
<br /> NorrWi- 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 www.everettwa.gov/permits
<br /> _ ROJEC i OIRMAT ON 4711712K-4200}10,13C
<br /> �<. ,�s�..�'�i*,v .�.... � -r-�3 „.-.-...,-,ea„a- .�,�,e..1� - ,. . .- u.'et��
<br /> PROJECT SITE ADDRESS1, rL0 Z PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ��kFl y a�e>i eta te=n. r �� 4:-44 ,x,` , I ' :..` ` `?i'E �.'
<br /> ���f �� �`t„� r� ,�s�:€�COI!�'�'�A�7}�,�F6�t.Mp�1O.N�� �� ;.r� ��.�,� ���� ._. �� -H.�a
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 1/GIA&A,-I�j� � ,,,,l,t�fL�. � 'Cc l i/ (' L C- f \ 7 tl Parirt
<br /> CONTRACTOR ADDRESS: STREET <F7z.j 3c.144,. A.-moi P
<br /> CITY ?ev'c.►3v e l J— STATE Pc ZIP T :TC)
<br /> CONTRACTOR PHONE: Y Z-�j,-,S7 ', 11 '14 CONTRACTOR EMAIL: rp,it VVcky -ey b,C ()_Y.p vtnt) , e
<br /> CONTRACTOR LICENSE#(REQUIRED): Met et Y9/Al Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) dtivbei
<br /> PRIMARY CONTACT: 0 OWNER rig CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: f( Z$,.1"?0, j)7c3
<br /> Bert X/Owv\ -✓ d — CONTACT EMAIL: V o n. a i/cwr� Qy� QL`- {.e„yWc k a eta
<br /> Bur DAN'' ERNS pO.,.A, g0,_ ,,X V
<br /> Existing Use of Building: A pcI+vere J Contract Price of Work:$ I6 ()Obi! --'
<br /> Proposed Use of Building: 54t4s Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ,EMulti-Family-#of Units: ®Commercial ❑Industrial
<br /> Type of Project: El New ❑Addition ❑Remodel 1;t1Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: , ArA,
<br /> LtMa ot, (a esiS-"r1 ij ook, usr S'vifpeo.,'± I10,5f t
<br /> Imo` Pl(aS el,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> $ I [EC ANICA 10,:t M tAkV I,CAtt0NXAx17100014101474/0:, ERIK#1t P4VAitiO STRE N
<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 /> 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 Official before being authorized under any circumstance.lam the owner,or lam 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 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> /- PERMIT*
<br /> Kit g f s w 5� �- 002--
<br /> Owher/Authorized Agent Signature Date (Revised 10/12/2015) \
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