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Pc(w.°r ±t ). 17®'1 — WI_ <br /> PERMIT APPLICATION <br /> "111140 /""-74 BUILDING /MECHANICAL I PLUMBING/SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I j b Z_ Cvz-•f'i6r(IA. bo 4‘)A /-1- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Jef ( 4- a,+.`1-. La' TENANT NAME(If Commercial): 3 e(( 04 i a,r,•< ZZ c <br /> OWNER MAILING ADDRESS: STREET rot Ca j' E tbJ v os <br /> ,,,9c+ 5:"F <br /> CITY 'y'i,r T l a..+ �( STATE Dt ZIP -(7Z©2. <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Q �....._ � WI,to, 4.6, <br /> CONTRACTOR ADDRESS: STREET '?0 e"iC hr 3 1 Q <br /> CITY`�PVC.l'C e,r°'� STATE /� ZIP -1 E3575i <br /> CONTRACTOR PHONE: 3(v0 NTL/G I`f'IM ( a CONTRACTOR EMAIL: t ;+�V'e c,-lb C" yea Lg f;- c't <br /> CONTRACTOR LICENSE#(REQUIRED): g g) N Jo 13(... 1-13 14. j CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) b713&) <br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3 u 0 "71-10 l'i't Lf <br /> t Ok"- `VMA:c CONTACT EMAIL: y1. Ae 19 i't to. 6 ate'("/0c)ie._-C 0""‘ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: <br /> � ;(LlT (o C 3(,� Contract Price of Work:$ 2-)&c®, 0a <br /> Proposed Use of Building: ORA..2,A.a t el'Z r s Heat Source: L"+7Gas ❑Electric,,.,, ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex����❑Multi-Family-#of Units: +LTC,bmmercial 0 Industrial <br /> Type of Project: ID New ❑Addition ❑Remodel ❑Repair Ly'I'.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ^ p f w raj <br /> (�,�4- (I toi2'r.. a^',L`� I,.1oc1 �' I�'6 P L T 4xsL) <br /> 4) b) (olz J- I I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of P oject: Kew — Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of # f /� 1#of <br /> List of Fixtures List of y <br /> ures List of fixtures l List of Fixtures <br /> Fi ,res u s .. Fixt -s fixtures <br /> "2, A/C-Air Handling Units Heat P mp \ / Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Uni H:.: "r Bathtub In Urinal <br /> Piping :bbl. Lavatory(W.: as ) Drinking Fountain <br /> f W:ter Heater R_, •era'on\ Shower , Floor Drain <br /> .as Fireplace ` ood SA Kitchen ' ' Disposal Grease Trap <br /> Gas Range 11 ti i Dis 1 :%er Roof Drains <br /> Clothes Dryer ..\.s Othe • Clot r asher Medical Gas <br /> Range Hoo. .= r. .t+ter Other: <br /> 1 Exhaust Fan ;5i k(Se e/Bar/Mop/etc.) Other: <br /> SP LA LER/S,�• -ESSION SY I �J <br /> 4 r hemi..)or W. er ` j Z of Hea., <br /> ACK OW DGEME ,:l h. e reviewed thi pplicat",n and confirm the • ation contained herein is true and correct.Work done pursuant to this permit must comply with <br /> curre ft fe eral,state,a .cal law.The granti •o :permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Buildi g*Mole!before being authorized under any circumstance.I am the owner,or I 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 /> 4,1 City of Everett Official Use Only <br /> 1 1y PER <br /> 9( MIr#� [1 1 lô <br /> �� <br /> Owner/Authorized Agent Signature t ate( (Revised 9/23/2016) Ff� <br /> z <br />