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PERMIT APPLICAT'1O A <br /> • .,;,_.;.. BUILDING/IVIECHANIO.A.L I PLUMBING I SIGN/SPRINKLER/DEMOLITION <br /> .,,. " � CITY OF EVERETT PERMIT SERVICES <br /> �r-z_. .;,.__.1•'T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)everetteps@everetfwa.gov i www.everettwa.gov/permits <br /> I( ®,®r t )I$4 _1(1.11 1.laiPlf0 s.6) •. 15,444'0T:44TE 11l ' l I 'ag . • ... . . .. . <br /> !PROJECT SITE ADDRESS: /6-7 Z6 " ZI ,51-- p r. Li.) ----s PROPERTY TAX#: <br /> LEGAL for new construction: Short Prat/subdivision Lot No. (attach copy of long legal description) <br /> :? • ,..:•:.—,...' 1: .. .. .. ... 01f.6"fli' 0.11.1 g f !fi : • .. .. .. <br /> OWNER NAME: Dean w-vi <br /> bi kjecv 073. � /TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET I 0 7 2 2J.S l C""/, (HJ T <br /> _ CiY :1_ STATE LL : ZiP '61 tog <br /> OWNER PHONT: .,J...sc4,3-eilv3'.. .R .,, ..... .., s.OWNER EMAIL: ... . �. . .. ,. _ .,,... ... . . „..., m ., .. ....�. <br /> CONTRACTOR NAME: E7�=(? (.' „L �yt&-•C� ttt C-. AL <br /> CONTRACTOR ADDRESS: STREET 2.i ZO PA-CJ t-Le-- <br /> Crry v '---(2.0ti STATE LOA ZIP 61 V2v C <br /> CONTRACTOR PHONE: (i+2..5) -2.52..-- ,5t(L4- CONTRACTOR EMAIL: 1.2-04.-40.,g-45 Gini ceJez..-e. it.-1 <br /> CONTRACTOR LICENSE#(REQUIRED): e-vErie,so -•p=— • !CITY OF EVERETT BUSINESS LICENSE#(REQUIRE]): _�j <br /> PRIMARY CONTACT: °OWNER ciACONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( 2s) 5-01_0---7z <br /> 12--EF:t.,J CONTACT ENTAIL: ,�p a 65/7 aa. .6J N <br /> -,. : ...• :.:... ':. :. : ... • :.>t3UII..L1.1(NG PI=IifVflf`I';t;PPL10ATIOfit' <br /> Existing Use of Building: Contract Price of Work:$ � �d, <br /> Proposed Use of Building: Heat Source: [(Gas N'Electric El Other <br /> Building Type: , SFR Detached ESFR Attached °Duplex OiMulfi Family#of Units: ❑Commercial 0IndusfrIal <br /> Type of Project °New E°Addifion Er Remodel Repair °T.1. ❑Sign °Sprinkler El Demolition °Change of Use • <br /> DESCRIPTION OF WORK: R 14£G &As r^ t A f„ 1 jvt„r,` � LO'C <br /> ,�L <br /> li� �I i <br /> • <br /> ASSOCIATED BUILDING PERMIT tri(if applicable): <br /> ,.•..•:?•..1001 ANgeA>L: E-R XT AP 01.ICA`0N. :: • • .: •••. P;C;�M011N6-010011t.:40.03(01:401 . <br /> Type of Project: New Addn Alteration ,_-__,Repair 1 Type of Project: __New Addn _ Alteration Repair <br /> #of List of.Fixtures #of List of Fixtures #of list of Fixtures #°f List of Fixtures <br /> Fixtures • Fixtures Fixtures Fixtures <br /> I NC--Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain r <br /> Water Heater Refrigeration Shower Floor Drain • <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher . Roof Drains 1 <br /> Clothes Dryer Hookups Other: - Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: , <br /> Exhaust Fan Sink(Service/Bar/Mop/8.h) Other: <br /> :::.11:11:;:. ;1?;"1(.ggit °1 bait i i.!')ki. `ti*etki.: . :.. . . <br /> Number of Heads <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the Information contained herein Is true and correct. Work clone 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.l em the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> and f comply with the State Contractors Law 98.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> id„,..„ <br /> 5-----:',44 - 2: 7 PERMIT, / flo <br /> O ic �d I �,II l 6,..... <br /> 1Un� <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) . <br />