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Ojtn. PERMIT APPLICATION
<br /> BUILDING 1 MECHANICAL 1 PLUMBING 1 SIGN 1 SPRINKLER 1 DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov l www.everettwa.gov/permlts
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<br /> PROJECT SITE ADDRESS: Cj 3 c i e"k(Cr _ PROPERTY TAX#: Q0 11 Ci F 0 C 060(J Ii0 ;
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNERNAME:
<br /> We,. pvrep f-f,-LV icy TENANT NAME(If Commercial): Wer/Ff
<br /> OWNER MAILING ADDRESS: sixawr 1 73 2_1 i/e. S y
<br /> cnY 11/41(- 0 rc STATE k/C-1 ZIP Cr ,.Z 72_
<br /> OWNER PHONE: L(2-5 -2 3 - 2-9(c(3 OWNER EMAIL://c s Tc. k,4,/& AtI/Otre,pP.G G vs,
<br /> CONTRACTOR NAME: , 6+5 HeecTit#1 q
<br /> CONTRACTOR ADDRESS: STREET 3't Oq Eve'T
<br /> CRY EV.r.e- STATE 4./A ZJP efgaQ 1
<br /> CONTRACTOR PHONE: Lf r Oct- 64-07 CONTRACTOR EMAIL:TDkr t•t6)6-SHp_ ,•r-fut8.e ot.t.,
<br /> CONTRACTOR LICENSE#(REQUIRED): ( J.„e.C.lir VAR It CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):l et6res-
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 42,6'" 3 OLt— •O 7
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<br /> BULL NS;PiRMIT'J►PP:LICA'r'(ON
<br /> Existing Use of Building: �1.)-P IGP Contract Price of Work:$32,g7-1..
<br /> Proposed Use of Building: Heat Source: ❑Gas terElectric 0 Other
<br /> Building Type: ❑SFR-Detached ❑SFR Attached ©Duplex ❑Multi-Famlly-#of Units: OCommerciai Dindustrial
<br /> Type of Project: ❑New ❑Addition teRemodel ❑Repair ©T.t. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: I4fi$d,4zoge
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Project: New_ Addn AIteration_Repair Type of Project New Addn _Alteration _Repair
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<br /> Fixtures List of Fixtures Fixtures List of Fixtures Fri of
<br /> List of Fixtures Fix#tu es List of Fixtures
<br /> 2 NC—Air Handling Units 1, 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 /> I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other,
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<br /> !Chemical or Water I 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.lam the owner,or I 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 18.27 RCW and 296.200A WAC.
<br /> r City of Everett Official Use Only
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<br /> j PERMIT
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<br /> O,, fter(Au�ttmoriz Agent Signature Date (Revised 9/23/2016)
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