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PERMIT APPLICATION <br /> BUILDING /MECHANICAL t PLUMBlNG /SIGN /SPRINKLER/ DEMOLlTION <br /> _ . . CITY OF EVERET7 PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT,WA 98201 <br /> {P)425-257-8810 � FAX 425 257-8857 �(E)����tt�'ps(��v�te,t�.��� www,.everettwa.govlpetmits <br /> ��;or�lack Ink. �e ` �f�OJECT SlTE 1'N�ORMAT�ON _ _ <br /> ?ROJECT_SITE ADDRESS: '_ , `- <. PROPERTY TAX#: �S��"`�;�}2.0��� <br /> _ _ _ _ _ _ __ __ <br /> _EGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT�NFORMATlON ' _ ,_ _ <br /> �WNER._NAME.... ; ; , `: TENANT N,AM� If Gc�t'ttner..C{�t�. <br /> )WNER MAILING ADDRESS: srReer �„ <br /> _.... <br /> cirv ` �TaTe ; ziP <br /> ._ _ _ <br /> }WNER PHONE: OWNER EMAII::: <br /> :ONTRACTOR NAME CO !�STi�N�E. •�Q'����lV� !l�. _ _ . <br /> , ,. _ . _,,, <br /> :.ONTRACTOR ADDRESS: s�aEer /71i2�/ /�T� �/�',i�,�„�t 6'�, OJ/� <br /> _ . <br /> _ _ _ <br /> cirr ��" �. LL- - __ �rnre �it�/4 rir= 9�/ <br /> _ <br /> :ONTRACTOR PHONE: : , ` <br /> � +�u"-�- • ' CONTRACTOR E�141L� .�� `, ;:.��t�`�fa�.C.GY� <br /> .ONTRACTOR LICENSE�(REQUI}��7�; ��j. �"1','„[,C/)'f CITY OF EVERETT BU8INESS LICENSE�(L�i�tll�L��::O.� �. <br /> 'RIMARY CONTACT: ❑OWNER Ga'G�ONTRACTOR ❑OTHER(Please Specify) <br /> ,::.. <br /> :ONTACT NAME: �ONTACT PHONE .t�Z6_�185--p//f <br /> K N� �� ���j3�""'���N ���,��� _.:: CONTACT EMAI�.� ������+h�j�GS` �k� <br /> ��'.tt'�i3 .:- �� = <br /> BUILDING PER��T APPLICATION .. <br /> =xistirt ;Use of Bu�tlit� ; '�` Contract Ptice of Work:� 21 � . •OC} <br /> __ <br /> 'i'� ,Use of'�.t�i� s <br /> Heat Source: ❑Gas �Electric ❑Other <br /> , <br /> �U..U�#T `F` :.,, ��D�t��e�t ❑SFR-Attached [?: �x.' ❑Multi-Famit �:ofUnits. OCommercial ❑IndusMal <br /> _. <br /> _ _ <br /> '°' e of Pr ` t ❑New C1Addition �Remodel- ° ,: ❑T.i. ��� " � r�rskler �Demolition l�G#e� e'of Use <br /> �E�(�i+F'!1'"i'Ii�N'OF WORK: , +�; _ _ _ _ _ _ _ _ <br /> �'��� �' l��'h�o7� �o�ri p0 Srt.�in't � / 1�u�. L'�2��'��a�7an <br /> � <br /> i►SSOCIATED BUILDING PERMtT�i if ic�tat�: _._ _ ... . _ <br /> _ <br /> . M�[ECNa�ItCAL PE1�111T APPL.��ATION ' PLUl4���G PE�T,�I�.IC,�kT�i; <br /> `ype of ProJect: _New _ Addn _Alteration _Repair Type of Project: _New �Addn _Alteretion ,Repalr <br /> #of Lls!of Fixtures #�f Llst af Fixtwes �of tlst of Fixtures ��t LTst of Fixtures <br /> Flxtures Flxtures Fixtt�l�es: Flxttt[es . <br /> _. _ <br /> `AiC—Air Handlin Units ' _ Heat Pump 7pilet ack ow Preventer lrtside Bid <br /> _ ; <br /> :Forced Air S stems Unit Heater �athtub Urinai <br /> ` ;'Gas Pi ;in __. .. _ __ Boiler `Lavato Wash Basin brinkin �ountain <br /> _ <br /> Water Heater ' . F2efri sration Shower Floor Drain <br /> : ;'Gas Fir�lace ' Waod'Stove Ritchen Sink 8 Dis .osal G�ease Tra <br /> Gas Ran"e : Ou�tin ` Disfiwasher Roof Drains <br /> �t��D �;r t�act#�a � Other<' G{othes Vllashsr , Medical Gas _ <br /> , _ 3�an e Hood _ YVater Heater 30ther: <br /> ' ��haust Fan Sir�k �ervice/.BarJMa /etc. Other: <br /> ' SPRI�KLER l SUPPRES$�0��SY�. � � � <br /> t#�n�r� ��s: � _ <br /> �CKNOWLEDGEMENT.!have reviewed this applicalion and confirm!he infarmafion contained herein is frue and correct.Work done pursuant fo fhis permit must compfy with <br /> ' urrent lederal,state,and locaf taw. The granting ol a pertnil only aufhonzes approved work and no deviations fherefrom.Devlations must irst be authonzerl in wnting from the <br /> ' tuilding Otfrcial be%re being autho�zed unde�any circumslance.!am the owner,oi I am aufhorized by the ownsr of this property to perform the work for which application is made, <br /> i: nd f comply with!he Sla�e Contracforslaw 18,27 RCW and 296;2QOA WAC,<. <br /> City o/Everett O�cia!Use t��i��+ <br /> PERM , <br /> o . <br /> ��a—i� � 03— 02 <br /> . ,�.� <br /> s ��!tMnAr,�AttY+ar�xe�d Agent 9,�gr�atur+� : Date {l�evxSe������f� _ _. <br /> ; <br />