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II II 1I 1'1I 44-77 PERMIT APPLICATION■
<br /> BUILDINU 1ldIECHANICAL/ PLUMBING/SIGN /SPRINKLER/ 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 1 www.everettwa.gov/permits
<br /> rx" .s Lam. ' $ _; ,moo - t * 0 a. Z 2. _ r,t .N t z r,
<br /> PROJECT SITE ADDRESS:5,2 D� j5evc147 L n PROPERTY TAX#: co 1 7(7 coo 02./ 0 0
<br /> LEGAL for new construction: Short Plat/subdivision H j 9 h/eA'c rpfr,S15.1t12. Lot No.2-/ (attach copy of long legal description)
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<br /> OWNER NAME: J,e.f.,ry ErLk n TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 52Qt eetic)-•f 7 t.-PI ' I
<br /> CITY (,(/c{� STATE Wj ZIP 9523^311-!,0
<br /> OWNER PHONE: y2 2 f2 (6D( OWNER EMAIL: _J c kI y 0- 'Olrf”cct e f�nstfro .?c ii-(,cotri
<br /> CONTRACTOR NAME: (UM t L
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: p6WNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: "/25—3z5_ 6,1
<br /> J,vrky t.)-c crkSdn CONTACT EMAIL:J.er ,yP?f`. 51-,ek1 rili)-J i,,e1-11.Cc,rn
<br /> '`4:y"i. a'�' ':5;`.'¢ '�.t�` �' ri.e �.�" r Fw . —:,:**1000070(10:0W;',::: '�" ,� 1Nu ar."'f�^� z�Y �sdxa
<br /> K :„s`'�. arlywt- ..� .r tAt ;_ �„_.�"'. B �5�'�y"�-„'Yrr»�, `""�:, �
<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of Building: i40 bb y 5 hop Heat Source: ❑Gas ❑Electric gOther Wc9hc_
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Idr p'C/I ) S<<u 1.7c��1 L'ec Uti''c Gdt ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> rS00010,1: : a . w ,10 t giMerill � i0,, ,j. e 11 � + ) lI1
<br /> Type of Project: _New — Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet 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 Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> INumbef 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 adhorized under any circumstance.lam 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 1 . 7 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ���� J� PERMIT# ��© r 00caner/ thorized Agent Signature Date (Revised 10/12/2015) ‘41�j
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