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PIrRfl1IIT APPLICATION
<br /> rt)111.11111PJ BUILDING I MEGH.ANIG.AL I PLUMBING 1 SIGN I SPRINKLER/DEMOLITION
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<br /> �Y ' � CITY OF EVERETT PERMIT SERVICES
<br /> 'w'. ''11--"°2/7i' 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)426-257-8810 1 FAX 426-257-8857 1(E)everetteps@everettwa.gov i www.everetiwa.gov/permits
<br /> f 'P:4F.•L 8 'Q 0.1(4As) .. 1PI OJJ>`GT 44TMi Olt 6 flA`iP1®g . ... .
<br /> PROJECT SITE ADDRESS: .-302_ .- SA cyLE, li-u_s PROPERTY TAX#:
<br /> LEGAL for new construction: Shod Plattsubdfvfsion Lot No._ (attach copy of Iong legal description)
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<br /> V. t'. ^ ..• 1 .. Ln. ••; 1.,.0. .. .J... 6b®►�1.1•(i;C •Ul, IP'® JIOIM •. . ••. •1'. `1 ''..1OWNER NAME: r�/L7 ; Gl cd.� 9 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET :136Z.5 Ac'w`-e, ,41,-/t
<br /> off? L'l,&••fz(;� STATE (i)4 . ZIP qV105
<br /> OWNERPHONE(4) ,31g gq . .w ,a.,,..,.. . .,�'OWNER EMAIL:
<br /> .r. ..... ..a, . .. .... ...�...�... . .>...,. .� ,. . .- �T.....
<br /> CONTRACTOR NAME: t 2L 2arC ELS Y Sit"t M teA6
<br /> CONTRACTOR ADDRESS: STREET 2-t Z0 PA-C-(14L
<br /> CITY j(--'-'12C--ti. STATE LOA ZIP q Z k
<br /> CONTRACTOR PHONE: `'tZ.5) -2-5'2,- ,5(114- !CONTRACTOR EMAIL: P-•(,),/40...g...%' r-I coa .-Ccd lti .
<br /> CONTRACTOR LICENSE#(REQUIRED): ~2 °,:50.7 err-- • lorry OP EVERETT BUSINESS LICENSE#(12EQUIRED):£004-7q5-....�.«,•,,,�•..��.,�„=.A".:.ter.,.U..�....�.w,<..�;�...,
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<br /> PRIMARY CONTACT: C7 OWNER CONTRACTOR C]OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (t2.5•) 3-64 c �
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<br /> 1L,�(� CONTACT EMAIL: vi--p 0S52-4 r . ,n4
<br /> Existing Use of Building: Contract Price of Work:$ ( Z r a ?- O 0 • •
<br /> ' Proposed Use of Building:
<br /> Heat Source: QGas *lactic QOther
<br /> Building Type: OFR-Detached CISFR Attached QDuplex OMulfi-Famliy-#of Units: QCommercial Cllndustrlai.
<br /> Type of Project: ❑New 1 IAddition IIRemodel IIRepair EfT.i. OSign OSprinkier Er Demolition OChange of Use
<br /> DESCRIPTION OF WORK: A 8 A�- to t=k+S'c-t 1,,c,, 61.•" ' (C ---„4.1,..)E x•LCA�"-- vLci-
<br /> \4 t T .)t•LL..41, "ki STC.,='u^-
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<br /> ;ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .;!;'...../. MSORPi icrnie»R >1:r"i> PLf0 T,YQN. " . Nifitil)JIN IE> UTA0PLpcA IIO ... : .
<br /> Type of Project: New Addn Alteration _..,Repair Type of Project: New Addn , ,Alteration Repair
<br /> °f • List of Fixtures
<br /> °f List of Fixtures of List oa+Fixfures 'Fixwr s List of Fixtures - I Fixtures
<br /> Fixtures Fixtures
<br /> Toilet Backflow Preventer(Inside Bldg)
<br /> A/C--Air Handling Units ( Heat Pump Bathtub Urinal
<br /> Forced Air Systems Unit Heater
<br /> Gas Piping Boiler Lavatory(Wash Basin) / Drinking Fountain
<br /> Refrigeration Shower Floor Drain •
<br /> Water Heater
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Ducting Dishwasher . Roof Drains
<br /> Gas Range
<br /> Clothes Dryer Hookups Other: • Clothes Washer Medical Gas j •
<br /> Range Hood Water Heater j Other:
<br /> Exhaust FanSink(Service/Bar/Mopfetc.)I Other:
<br /> ::::..",11.;:.:.
<br /> .": #. lilts 10 .! 11016. it... ..V0`4 , .• j'
<br /> -(Number of Heads
<br /> tCKNOWLEDGEMENT.•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 /> >urrent federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first he authorized in writthg from the
<br /> 3uifdfng Official before being authorized under any circumstance.I am the owner,oriam authorized by the owner of this property to perform the work for which application is made,
<br /> !rid i comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett oh7cfat Use only
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<br /> , (S 7 PERM(t ` (602:.
<br /> o2 — bk..k Lo
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<br /> Date (Revised 6/20/209)
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