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PERMIT APPLICATION
<br /> /� BUILDING I MECHANICAL I PLUMBING/SiGN/SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> , 4I'" :TT 3200 CEDAR STREET,EVERETT,WA 98201
<br /> \ '� (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: r 0 PROPERTY TAX#:
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> !OWNER NAME: t , j'f,4,,,,1,s TjAL1 -444,7,0-45, TENANT NAME(If Commercial):
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<br /> OWNER MAILING ADDRESS: c STREET /q g% 500 4 r. t' ) /�jx` //d
<br /> 1 CITY /AL 14 t/-)QC,C STATE !1 t/ , ZIP 9��3..
<br /> OWNER PHONE: L125 -7 5 0 "7 y L6 OWNER EMA4,0, l/41 yy/S/4 9T -
<br /> CONTRACTOR NAME: -J k op ( -Z-P e--. '
<br /> CONTRACTOR ADDRESS: sTReei / /RC.)i 5/0-":' 7th_ iii
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<br /> CITY 1..t kt y,e.' STATE �x1 ZIP '/Y-03_67/ �^
<br /> CONTRACTOR PHONE:4t2 -7'ScJ/-2,7 �c�CONTRACTOR EMAIL: ` �� , //r,�a. ,c/d?,, ..A��
<br /> CONTRACTOR LICENSE#(REQUIRED): -/k� &L 6 /v 5 CiTY OF EVER T BUSINESS LICENSE#(REQUIRED): 051 G 1 yc
<br /> PRIMARY CONTACT: J]OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> r`il« ."....__ f-�. t, CONTACT EMAIL: -' 'Y -5 47-:;c-- -1.-1—.—
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<br /> _ itittfliailiNG•PERM TAPPLffCATd il is.:_t _. ::.-._._ " = -..
<br /> Existing Use of Building: ,,, , / ANIENIMI Contract Price of Work:$_ L `.,_,
<br /> 'Proposed Use of Building: ep- 1;c r Heat Source: 1; as I tlectric ❑Other
<br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: •RiCommerciai ❑Industrial
<br /> Type of Project ❑New 17Addition ❑Remodel El Repair WI. ❑Sign ©Sprinkler ❑Demolition ❑Cha ge of Use Q, �g�
<br /> DESCRIPTION OF WORK: C A�/wv^� LcV W h
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> YNdEC 2�i1GlftiLL P�SiRkVt17'rA�ll:0,10# 'd®Rl i. _. .�kI r-.. .�_< Ea4011.j 0-4.0.0l�iiil)IY' iP�0000g4N E :: 1
<br /> Type of Project: _New_ Addn Alteration Repair Type of Project: New Addn Alteration epair �,. f
<br /> #of #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtu es Fixtures Fixtures Fixtures u
<br /> Fixtures
<br /> A/C-Air Handling Units Heat Pump "Z-- Toilet Backflow Preventer(Inside Bldg)
<br /> / Forced Air Systems Unit Heater Bathtub Urinal !
<br /> 1 Gas Piping Boiler •::E. Lavatory(Wash Basin) Drinking Fountain
<br /> I Water Heater { Refrigeration . Shower Floor Drain
<br /> Gas Fireplace Wood Stove 1 Kitchen Sink&D.is.osal Grease Trap ='
<br /> Gas Range Ducting Dishwasher Roof Drains t
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas l
<br /> i Range Hood Water Heater Other. II
<br /> 'Z_ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
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<br /> SP11841 9lI L L `7`>fAi 1�i T E4-4 Le 1 S YSifelit z
<br /> } Number of Heads II
<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 �l
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<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 ii
<br /> Building Official before being authorized under any circumstance tam the owner,ort 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 296.200A WAC
<br /> City of Everett Official Use Only
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<br /> Owner/Authorized Agent Sig ature Date ( vised /2/2015) II!
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