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<br /> PERMIT APPLICATION
<br /> BUILDING I MECHANICAL!PLUMBING J SIGN 1 SPRINKLER 1 DEMOLITION
<br /> ,,,,%,404CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)
<br /> severetteps©everettwagav I...wmmws
<br /> everettwagov/permits
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<br /> PROJECT SITE ADDRESS:Qg1fwkE - , tvEt TT, W ” (Orr 8jPROPERTY
<br /> TAX#: O 13 000001110)–
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME:ASH ISP SANAN k-SR,VAN) . ANAM ENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET �y4 pi
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<br /> city rex:I'�r 0 tk ! STATE CA. ZIP "r r 5 J I
<br /> OWNER PHONE: E -- 'S'Z: Q 54,_,. .,1„.,,, ]0WNEREMAILM A C.•
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> CRY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: af OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: 4 3 I S 11 ,CANiitrii CONTACT PHONE: 510.-S'52- - 05
<br /> 'CONTACT EMAIL: A-, A-IJ• N &M A 1 L. C,0 M
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<br /> Existing Use of Building: 1Z.'E$1 6 IJ1)AL. Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: OGas DElectric DOther
<br /> Building Type: DSFR-Detached JB SFR-Attached ODuplex .1Multi-Family-#of Units: 2- ❑Commercial ❑Industrial
<br /> Type of Project DNew DAddition ORemodel ORepair DTA. DSign DS rinkler ODemolition ©Change of Use
<br /> DESCRIPTION OF WORK: THEM ).r,,' A CP Al P 1'J W A t E G MS(O Z, )N V?I T A, ? ssi Tv
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Project: New — Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair .
<br /> #ofof List of Fixtures #of List of Fixtures # List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures ,
<br /> A/C–Air Handling Units Heat Pump Toilet A 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 'Grease Trap --------
<br /> Gas
<br /> Gas Range Ducting Dishwasher 'Roof Drai
<br /> Clothes Dryer Hookups Other, Clothes Washer • I
<br /> Range Hood Water Heater Other:P1JJW tn$A.1:':'k MeTet
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: ilk) t>VNIT A
<br /> Chemical or Water No.of Heads
<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
<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,ort am authorized by the owner of this property to perform the work for which application is made,
<br /> end I comply with the State Contractors Law t 8.27 RCW and 298.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
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<br /> ,,g,:,,,„„,„,„,, 6 a k (-,.raw- 01 S.011-01 C-107- OO
<br /> Owner/Authorized Agent Signature Da (Revised 9/23/2016)
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