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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL I 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 1(E)everetteps@everettwa.govt www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please} PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS; I: L1'f i TA, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> INNER NAME, <br /> t <br /> t...A ji.A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET , <br /> crrY SII ik, F " <br /> STATE .- r LIF' <br /> OWNER PHONE:; tro # or. OWNER EMAIL: <br /> CONTRACTOR NAME AA A igaili ii ' <br /> CONTRACTOR ADDRESS: STREET - <br /> STATE ZIP ? <br /> CONTRACTOR PHONE: vc.. k; wolit CONTRACTO EMAIL 1� � 1i C' <br /> CONTRACTOR LICENSE#(REQUIRRED): #' O = I'# r} CITY`OF EVERETT BUSINESS LICENSE#(REQUIRED):1111 j <br /> CONTACTPRIMARY CONTACT: 0 OWNER Iv4 CONTRACTOR 0 OTHER(Please Specify) <br /> J CONTACT PHONE: <br /> rilf <br /> BUILDING PERMIT APPI,CATION <br /> cisti'a Use of Building; Contract Price of W,rk:$;: <br /> Proposed Use of Building: Heat Source: OG-- ZdElectric ■Other <br /> Su1tdin6T".pa< OSFR-Detached ❑SFR-Attached I Da.lex Okfulti-Fam`tl 'of Units: ■Commercial Olndustrial <br /> Type of Proect ONew DAddition ❑Remodel ©Repair OT.I. OSI+n _.OSprirlcier ❑Demolition OChartge of Use <br /> DESCRIPTION OF WORK: <br /> 11 <br /> ASSOCIATED BUILDING PERMIT# tf applicable)._ i_tiC yr. I - <br /> �.... <br /> plot-411'�." RMI APPJICATION PJJJMBIFIG PERMIT APPLICATION <br /> Type of Project _New Addn _Alteration __Repair Type of Project _New Addn _,Alteration Repair <br /> #of List of Fixtures #of <br /> List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units jHeat Pump Toilet ~Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal ` <br /> GzisPipin Boiler Lavatory(WashBasin) " Drinking Fountain <br /> Water Heater Refrigeration ` ,iShower Floor Drain <br /> Gas Fireplace _Wood Stove : ;Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting DishwasherRoof Drains <br /> Clothes 0 er,Hooka's Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater ,Other: <br /> -,, <br /> Exhaust Fan <br /> Sink(Service/Bar/Mop/etc.), Other: <br /> I t,,' 1,-s3stiOttittEtsviti.NlitiOttivi <br /> lNumber of Headsi <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.tam 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 /> City of Everett Official Use Only <br /> PERT <br /> 664 #7 1 if10 11 Q - 0 0 <br /> Owner/Authorized AgentSlin=tore Date. <br /> (Revtsf' "20I201 6)_ <br />