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PERMIT APPLICATi�� <br /> , ��I�.�� Itlf��HA�11�4L� p��l�'�C���/�a1�' �I�L�1�� ���l1��f1'r��l <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> ��t#�e +�r�l,ac�t�n�=�a�11 F!���s+�.` � R����"'�"1` SI'f'� �����1�I�'�''�C�N �;: <br /> PROJECT SITE ADDRESS: 5704 EV@I" reen Wa Suite D PROPERTY TAX#: 0O393ZOO4OO700 <br /> LEGAL for ne�v consfrUction: ShorY PlaUsubdivision Lot No. �atiach copy of lony legal description) <br /> ,�►�'� � r�`���,�',��+��� ? <br /> ,.. .. .. _ . ..., .... . . ,.� < . . <br /> OWNER NAME: Hur Pro erties LLC TENANT NAME(If Commercial): XUB�III Wan I u�5 <br /> OWNER MAILING ADDRESS: sTReeT 7100 Ever reen Wa Stuite A <br /> CITY Everett STATE W/q ZIP 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CBNTRACTtyfi NANIE', <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> .t:. „ ...:, _.,. . ..; ..�::. ..: ., . ...: ... .,: �., ....:. . . _: - � <br /> .. . . ......:. .. .... ,..: �._ ... .:. <br /> ,�Y�+1'��G�'. ?�{ 111�i�f3 ��' �?f��'�1#��R i �'�I�i�Please.Spe�sify) '���I�fy�f <br /> CONTACT NAME: �eSSICa KG'1'SG'y coNTacT PHONe: 425-516-7541 <br /> CONTACT EMAIL: jkersey@gc2seattle.com <br /> ,':.$�1Lt3t�1'�:FC���'�`��'�,#��kT'M!�?�+1 : . � . . <br /> Existin Use of Buildin : Orprpg 'a� Contract Price of ork:$ <br /> Pra sec�Use a�Bui#di : �QI�!'k�C���k kteat S.ttwrr�:: �K eetri� �� r: <br /> Buitdin T e: �� FR-Detached �FR-A#tached f� u i�x �� attt=Fatrw€C #�#Glc�its: ., rr�rEi�ii �� ustri�l <br /> T e of Pro'ect: sF ew �� ddition 6� emodel �� e air .L 6� i n �t rinkler �t emolition 6� han e of Use <br /> DESCRIPTION OF WORK: TI of existing commercial space into a massage service company. <br /> Adding separate rooms, laundry and shower area. <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> (� ; _ . : ,. <br /> ; ..,.�����i�'�`,�'�"'�`��r�i���:.1 , : `: . ., `. ,. _.; ��-�f�N��R�:°��';�",��,��f ,,: ' '. <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Flxtures #of List of Fixtures #°f Llst of Fixtures #of Lisi of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handlin Units Heat Pum Toilet Backflow Preventer Inside Bld <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavator Wash Basin Drinkin Fountain <br /> Water Heater Refri eratiQn Shomrer Flnar Qrain <br /> �a,s�k '4�caod�S�aue. �Ci�6c�iem�Srmk&�5qs as� Gre�s��Tra =. <br /> Gas Ran e Ductin Dis�iwas�ier Roof Drains <br /> Clothes Dr er Hooku s Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other: <br /> S�"t�i��tEl�t�1,���'���$1���„M'$"���.,:� <br /> Chemical or Water _ No.of Heads <br /> �1�KhIt3tN�£D�EN1EfilT:�i�ave revieweo'this applit�fion ano'eflnfirr�:tt3�e ir�lorr�at��enr��asr�eo'herein is trve arad cs»rsat.'tN�rk c�rrrtae�a�io:�his.p�trrrft;rra�sf.r,rar.�pty� <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 /> 8uilding Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law i8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only �11; <br /> d <br /> , � �� l�� PERMIT#� D�J 'O� O � GI'L <br /> / ��j o <br /> Ow uthorized Agent Signat e Date (Revised 9/23/20i6) <br />