|
- ���6�1�'A��'LICA�'CO
<br /> ti �L�Il�.DI�'f1�i�CF�A�iCAi.1��.l1iill�li�t.�l SI� I��9i�P��E�/ D�i�O�.I`��OYlI
<br /> CITY OF EVERETI'PERMiT SERVIC S
<br /> . 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 j FAX 425-257-8857 �(E)everetteps@everefiv<<a.gov f vvww.everettwa.gov/permifs
<br /> .. .. . . . , . - . .. . •
<br /> (�9��.��1�8��1���au��avIIy f����s�� � . ����A�(�`�"�➢'�'E� �f�1�'�G3�fd�'�Il�I�V .- : . . � .
<br /> PROJECT SITE ADDRESS: �7 I� {�";�:.'-� .�` � ��"' PR.OPEEiTY TAX#: � �V�I �� .
<br /> 1.�GAL.for new consfruction: Shorf Pfaf/su6div(sion Lof No. (atfach c�opy of Iong legal description) � ��
<br /> :.:; ..- .,-.:.,. . ., . <- ... ..... . .. . . . • .. . . .. _ .
<br /> �... _ ... ..-., ... .. .,.., �-... ....._... _.
<br /> . . ,.. . :.... .
<br /> : : . �• �. � .. , ��I�!'�A�`�'�R'�1F�f�i�i,l�'�'���( : .
<br /> OWNGF2�[AME: ����'rc��,.r. S�`',� t`''�4'�t� � � ���� �� ��� 7ENANT NAriI(E([f Comm�rcial):
<br /> OWNEF2 MAILING ADDRESS: srReEr `� 1 � :.=% ��-' t t � �
<br /> ''"" s-ra-re . -4 ziP ���`�`�"`j
<br /> c�rr •-
<br /> ., _
<br /> OWNER PNOyE: �j�=' - � , OW�{ER EiV1All.� � �,
<br /> ,..�,.......,.... ........ .....-.�_........... .. .. �.,
<br /> ..� .._.:.._ .. ,...M.,
<br /> C�NTRACTOR NAME: (.�,9=( — > — �- ��
<br /> CONTRACTOR ADDRESS: sr�eEer Z..i ZO �V.� L�-
<br /> CIiY � �' STA"fE �;� ZIP ���-EJ �
<br /> CONTRACI"ORPHONE: S�Z� 'Z�'L4 3t('+ CONTRACTOREMAIL- 1•LG�'i.C�2_Q'`r.`���t1,t�i..=C.�DN.�(
<br /> CONTRACTOR LICEM1ISE#(REQUlRED}: j_�C(L�� ' �� CiTY OF EVERETT BUSINESS L(CENS�#(R�QUIRED} � �
<br /> ,:�,..... T.._.�.,�,_ .. ._....w.,.,,....>...__...�_� ,.., �„ ,..��.,...... _.�. .,_.,..,,-..r,_ �,...��__..., ._
<br /> PRtMARY CONTACT: ❑ OWNER `�CONTRACTOR ❑ OTNER(Please Specify)
<br /> CQNTACT PIAM�: , CON7ACT PHONE: r,�..�� s�� .—�j--7' ;�,
<br /> �L��,� �� CONTACT EMAIL: ����E�'.�c'�j�,I���,.�y�q
<br /> . .. . . .. . .. . :...:...... . . . .. • .
<br /> ,. .•..-�. . . .� . .
<br /> . ..,.. ... ..... _...... . . . .. .
<br /> , . .. . ,
<br /> .:.
<br /> . . . .-.,BUILDING.PERMI7;,APPLI�ATtOIe! � �
<br /> ��.__ .: . �„�
<br /> Existing Use of Building: Contract Price of Work:$ -`� �.�a�-��'.
<br /> Proposed Use of Suiiding: Heaf Source: ❑Gas lectric ClOther
<br /> Building Type: ❑SFR-�etached ❑SFR Aitached QDuplex ❑Multi-Famify-�#of Units: ommercial ❑Industrial
<br /> Type of Project: ❑New ClAddiiion ❑Remodel y�+-cepair ❑T.I. ❑Sign ❑Sprink(er ❑Demolition ❑Change of Use
<br /> DESCRIP ION�F WORK:
<br /> `��i���- 5�(�fi �ys�� N�r ��.4W-� ��,c.�
<br /> ASSOCIATED BUILDING PERM[T#(if appiicable):
<br /> , . ._�:..:. ......... . ... . ... . . . .. .. ....._. . , • . . -
<br /> .. .. . . ...........:. ... . ..
<br /> ...:, ,,. . .. . . . '
<br /> ,.�. _.:...�ur���r��_r�,��: ����nar����r��rio�� � - ���. . �����fl�� ���n�s�.:w���p��,�ra�� .� . . .
<br /> Type of Projecf: _I�ew ___, Addn Atferafion _,Repair Type of Projecf; _New _Addn Alferation _Repair
<br /> �°� Lisf of Fixiures ��f List of Fixfures ��� List of Fixtures ��� Lisf of Fixfures
<br /> Fi�ures Fixfures Fixtures Fixtures
<br /> A!C—Air Handling llnifs Heat Pump Toilet Backftow Preventer(Inside E31dg)
<br /> Forced Air Systems Unif Heater Bathfub Urinal
<br /> Gas Piping Boiler Lava�ory(Wash Basin) Drinking Founfain
<br /> Water Neater Reirigerafion Shower Floor Drain �
<br /> Gas Fireplace Waod Sfove Kitchen Sinl<&Disposal Grease Trap
<br /> Gas Range Ducfin,q Dishwasher Roof Drains
<br /> Clofhes Dryei•Hooku�s Other: Cloff�es Washer Medical Gas
<br /> Range Hood Waier Heafer Other:
<br /> Exliaust Fan 5ink(ServicelBar/Mop/eta) Other:
<br /> - . _- ..........:.:...--.:........ ......_,._.,....:.. . .
<br /> _.,-�..,. .......,. . . . . . .
<br /> ....�'::':: �1F'R➢F�9�H���_/��1!PG�'�1�.���d��'l;��"�`�`�flil.. . :.�
<br /> Number of Neads —
<br /> ACKNOWLEDGEME�UT.�l have reviewed this applicsfion and contirm the in;ormaiion contair,ed herein is fruo and correct. Vl/crk done pursuanf fo ih�s permit rnusf comply v�rfh
<br /> cur�ent federal,sfafe,andloca!law. The granting of a permif only outhonzes approved v✓ork and no deviafions therefrom.Deviations musf rrrsf be aufhonzed in wrifing from the
<br /> DuiJding Official before being authorized under any r.frcumsfance.l am the o+!✓ner,or!am authorized by the owne�of this propert/fo peiform the work for which applicafion is made,
<br /> and/comply wffh fhe St�fe Confracfors Law 18.27 RCW and 296.200A INAC.
<br /> City of Everett Of�cial Use On/y
<br /> ��� PERMIT#
<br /> �
<br /> .�.�.-- �...�--��`��� /2��;7—!� � �Z_
<br /> Owner/Aut(iorized Agent Signature Dafe (Revised 5/20/2016) �
<br />
|