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425-252-1666 c.m.heating 13:31:38 12-30-2015 2/2
<br /> PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING I SIGN/SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVEREfT,WA 88201
<br /> 4E7T (P)425-257-8810 I FAX 425-257-8857 1(E)everetleps@everettwa.gov I www.everattwa.gov/permits
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<br /> PROJECT SITE ADDRESS: O DSI D j� t 7 u V G do to PROPERTY TAX#:
<br /> LEGAL for new construction: Shod Plat/subdivisian_ Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: D G N
<br /> —1 y� TENANT NAME(if Commercial):
<br /> OWNER MAILING ADDRESS: STREET` L -t-Q� LA
<br /> t cay STATE Wil ZIP
<br /> OWNER PHONE: —I a 5 " OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET I5 Bro wag
<br /> CRYEvipreftSTATE w 1,, YIP
<br /> CONTRACTOR PHONE: � .V9 Cp&G4 CONTRACTOR EMAIL: crAked4"rl • com
<br /> CONTRACTOR LICENSE#(REQUIRED): C H _--og5R L1 CITY OF EVERETT BUSiNESS LICENSE#(REQUIRED): ���fia8
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<br /> PRIMARY CONTACT: O OWNER (`CONTRACTOR O OTHER(Please Specify)
<br /> CONTACT NAME:: CONTACT PHONE: 25 2.5q�''► wi i:/aUt.rs CONTACT EMAIL: deWe & CI'1QI ie or fri • Caro
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<br /> Existing Use of Building: Contract Price of Work:$ I o Q
<br /> Proposed Use of Building: Heat Source: as OElectric Other
<br /> Building Type: ❑SFR-Detached 4FR Attached ODu lex [31001-Famit -#of Units: C]Commercial ❑industrial
<br /> T e of Pro ect: ❑New OAddition Memadel ORe air OT.I. Oft n OS rinkler ❑Demolition ©Chan a of Use
<br /> DESCRIPTION OF WORK:
<br /> �;NS�• �� w�o� ST�v-� -
<br /> ASSOCIATED BUILDING PERMIT# if applicable):
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<br /> Type of Project: , Now Addn ;Alteration repair Type of Project: _Naw ^Addn �Alleratiany ,_Repair}y~
<br /> Fixtures List of Fixtures Fixtures UstofFixtures Fixtures List ofF/xtures Fixtures t_isiofFIxturas
<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 /> WaterHeater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal I Grease Trap
<br /> Gas Range [Ducting Dishwasher I Roof Drains
<br /> Clothes Dryer Hookups—- Other. Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other.
<br /> Exhaust Fan Sink Servtce/ear/Mo /etc. Other
<br /> .�7,4.�01 - �WSPPRESS O
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confrm 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 authorkes approved work and no deviations therahom.Deviations must first be authorized In writing from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or I am authadzed by the owner of this property to perform the work for which application Is made,
<br /> and I comply with the State Contractors Law l&27 RCW and 290.200A WAC
<br /> City of Everett Official Use Only
<br /> PER
<br /> 3s— 1 1 -6
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<br /> 66r/Authorized A t Signature n to (Revised 10/12/2015)
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