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PERMIT APPLICAT Ir.-I1 <br /> BUILDMIS I MECHANICAL I PLUMBING I SIC: SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ( {aa ,sao'.( 8� s"1(uit�s._�>r91f}I l0oaisi3) 1G ®�t �T aQfl'I gi91 ®I ��111(®i4. :. <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME_` =�L. /��,✓F- TENANT NAME(if Commercial): y <br /> OWNER MAILING ADDRESS: STREET <br /> CITY ' STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: E7 <br /> CONTRACTOR ADDRESS: STREET Zi ZO , tL <br /> CITY STATE l(IQ ZIP <br /> CONTRACTOR PHONE: 4Li Z!5 25'Z- 3l (�f CONTRACTOR EMAIL: �^ "�1 C �`S�s ir►�14 j rC t�i�'S <br /> CONTRACTOR LICENSE#(REQUIRED); Gvi;n ;y CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: Q OWNER ` Y CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z� <br /> 14(---(J �L-4;1 CONTACT EMAIL: <br /> BUILDING.RE-R' M*'.APPLI ATION <br /> Existing Use of Building: Contract Price of Work:$ �G <br /> Proposed Use of Building: Heat Source: XGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Affached ❑Duplex ❑Multi-Family#of Units: Commercial F]Industrial <br /> Type of Project: ❑New, []Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ClDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,-E L C ��''S 1 apt �t3 C t �7l l-r-WE -7) i2e-r-LtWl : 1 V-GS C Carr ev <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> iVlA7A1P',1L1tAt'0"' <br /> �1�lJIl�D1fIP�� <br /> Type of Project: —New _ Addn rt[on .Repair TypeofProject: ,._,New ^Addn A[terafionRepair <br /> ##of List of.Fixtures List ofFixtures #ofList of Fixtures #ofList of Fixtures <br /> Fixtures s Fixtures Fixtures <br /> A1C—Air Handling UnitsHeat 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 fE 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 /> Sp If' KL.> 10 w1r�1 <br /> Numberof Heads <br /> ACKNOWLEDGEMENT.t 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 ofa permit only authorizes approved work and no deviations therefrom.Deviations mustfirst be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# ;\ <br /> 4 .71 <br /> Date (Revised 512012016) <br /> OwnerlAuthorized Agent Signature <br />