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<br /> PERMIT APPLICATION
<br /> 4`` BUILDING/MECHANICAL I PLUMBING I SIGN/SPRINKLER/DEMOLITION
<br /> :,,`,. , f. CITY OF EVERETT PERMIT SERVICES
<br /> ' "�,=' .`1:-L-2/7 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 426-257-8857 1(E)everetteps@evereftwa.gov www.everettwa.gov/permits
<br /> Mr. , 1iiigillitk 1siQj 0.1(0 .6.) • k...46441t .; 0.TON.O.O• Rid 1551'1(®1 • ... . •. • . • • .•. .. -
<br /> PROJECT SITE ADDRESS: '7lG, �,/f E7/�E72 Zai PROPERTY TAX#:
<br /> LEGAL for new construction: Short Piat/subdlvlslon )Lot No. (attach copy of long legal description)
<br /> :. .. .. ...0(5.10;401‘11)004i1-1101 .1101 : .. ::.' .. . . ..: . • :,
<br /> OWNER NAME: /,XL(' e:-/...,--74-/-/ / /L�j TENANT NAME(if Commercial):
<br /> [/ '
<br /> OWNER MAILING ADDRESS: STREET /e b4U L — I
<br /> CnY 6?ii .GJ
<br /> r STATE 11.—/A • zIP 4 Z�D�j
<br /> OWNER PHONE: . ,.., 355. .,,...,. ,. !OWNER EMAIL: ,.. . ... .... ..�.,. . ..,...,. .e ....�.
<br /> CONTRACTOR NAME: 2L (2A ( V Ad-
<br /> CONTRACTOR ADDRESS: STREET Z.LZO PA-Q,..4-i.e....
<br /> cm, W� STATE LOA ZIP Ci C 2-e D
<br /> CONTRACTOR PHONE: 11-(-2.5) 252- 3((4- CONTRACTOR EMAIL: I-2-gm-Q._ --'3S‘V-vt cJ�: M•,j ��//��
<br /> CONTRACTOR LICENSE#(REQUIRED); C-ve¢�s o - (CITY OF EVERETT BUSINESS LICENSE#(R> QUIRED): (� ifj _,,i
<br /> .�.._�.. r..z,..,.,=..�;t �:�=,._w..,.�Y�-,..�,a„�.-tip ....- �,.�..-s�....,,,.....�•..,.�� -
<br /> PRiMARY CONTACT: O OWNER CONTRACTOR 0 OTHER(Please Specify) •
<br /> CONTACT NAME: CONTACT PHONE: (4,...n) s© C17 Z
<br /> `LL(v C.G) CONTACT EMAIL: u 4&SSS/1,641..6"�1
<br /> ._ .... ...... ::. :,,. ,BUILDING.PE RMIT;A•P17.LIGATION • • • . . •.. .
<br /> Existing Use of Building: Contract Price of Work:$ 3, C? j(
<br /> Proposed Use of Building: Heat Source: ❑Gas 'Electric El Other
<br /> Building Type: SFR Detached ❑SFR Attached ❑Duplex ❑Multi Family#of Units: ❑Commercial ❑Industrial_
<br /> Type of Project: ❑New E(Addition ❑Remodel piRepair OT.i. OSign OSprinkfer ❑Demolition ❑Change of Use •
<br /> DESCRIPTION OF WORK: r•i O�„� � 1� (z'1� �
<br /> •
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .:::s..::::•.IIII1 .0141011P,4 0..* pl1.'>":40 1 1001.®1\!' ,' 112N-0-01 IN 4 :4 1 Pl gcATioN . ... .
<br /> Type of Project: _^New Addn Alteration Repair , Type of Project: New Addn Alteration Repair
<br /> #of List of.Fixtures #°f List of Fixtures #°f List of Fixtures I #of List of Fixtures
<br /> Fixtures Fixtures Fixtures : Fixtures
<br /> A/C—Air Handling Units Heat Pump . —Toilet I—Backflow Preventer(Inside Bldg) 1
<br /> I Forced Air Systems Unit Heater 'Bathtub I—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 i—Grease Trap
<br /> Gas Range Ducting Dishwasher S Roof Drains
<br /> Clothes Dryer Hookups Other. —Clothes Washer —Medical Gas
<br /> Range Hood . ' —Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.):=Other. !•
<br /> --INumber of Heads
<br /> ACKNOWLEDGEMENT'I have reviewed this application and confirm the Information contained herein Is Prue 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 I am the owner or I am authorized by the owner of this property to perforin the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 ROW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT
<br /> 142-.4" ------ '6 e•4 "7 - i -i-7 no - 02) i
<br /> Owner/Authorized Agent Signature Date (Revised 5/2.0/2016)
<br />
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