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PERMIT APPLICATlON
<br /> BUlLDING i MECHANICAL.i PLUMBING/SIGN!SPRINKLER/DEMOLtTlON
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STi2EET,EVEF2ETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everettepsQeverettwa.gov� www.everettwa.gov/permits
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<br /> Slu�air.�lack 1pk On1y;Please) ': PRt���,CT��TE;INFO.RMi�T�!ON,�' �,..;,.`.,'" . ;,;.>�.._ ' ;` ;:
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<br /> PROJECT SITE ADDRESS: 3�a� � r?�.I•�-„ I p PROPERTY TAX#: �� 57�'GlQ� (�+�
<br /> LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of(ong legal desc�fpdon}
<br /> � > , ,; ; , .aL�NTA�'INFORMA�tlON:i .�... r �: ... ,.. ,.
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<br /> OWNER NAME: ,- � y- �4 TENANT NAME(if Commerciai):
<br /> OWNER MAILING ADDRESS: srReeT � ')(j� ,��I t�-a I . �
<br /> �� ��.e�77 STATE LP �ga o�
<br /> OWNER PHONE: C'{r�� �7(i �{�{S°� OWNER EMAIL: : t �brr;S " t�m�`� � �
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<br /> CONTRACTOR NAME: I ��� � � p i �„�
<br /> CONTRACTOR ADDRESS: srne�r 73�j �{7"�t` '. � (,�
<br /> � � CITY 1[` r1'"' . . . ��.. � . STATE UP g�7S . � � �
<br /> CONTRACTOR PHONE: � �j�j�j � CONTRACTOR EMAIL: �j' ��S S � ,�� .�
<br /> CONTRACTOR LICENSE#(REQUIRED}: � �GR� l ��t� CiTY OF EVERETT Bl15lNE5S UCENSE#(REQUIRED): ��� �
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<br /> PRlMARY CONTACT: O OWNER l�CONTRACTOR ❑OTHER(Please Speci€y}
<br /> CONTACT NAME: CONTACT FHONE: c� [ ((j,�,r �"��y �j
<br /> � C , 5•'��(��� CONTACT EMAIL: (f„G�a`'��
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<br /> Existin Use of Buildin ', { -�a,�, Contraat Price of Work:S �
<br /> Proposed Use of Buildin : Heat Source: jSGas ❑Electric ❑Other
<br /> Buiiding T pe: �9SFR-Detached OSFR-Attached ❑Du lex �Multi-Famit -#of Units: ❑Commercial �Industrial
<br /> T e of Pro'ect: ❑New �Addition C7Remodel �Re air OT.t. ❑5i n OS rinkier ❑Demolition C7Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> �.i�{ `[lr. �t V� •�V'�d Lt' f"��1ln(�GwPb+�
<br /> ASSOCIATED BUILDING PERMI7# if a licable:
<br /> `r��.;:����ip�i�,1�AL,�"�R1�iT .FP1.�C�'���a.:��.�`�„ r�r`.�"�,�:� ...,.,.. .:!'L�1_f�kf1�1.;;GX'.�'�k��VI1T�r��'d`,tCA7�ON �,�_
<br /> Type of Project: _New Addn Alteration _Repair Type of Projeet: lNew _,_,/�ddn Alteratloa _Repair
<br /> fitxtures ust of Ffxtures F��� List of Flxtutes �J�� Ust o/Flxtures ���5 Lfst of Hxtures
<br /> A/C—Air Handlin Units Heat Pump Toilet Backtiow Preventer Inside Btd
<br /> Forced Air S stems Unit Heater Bathtub U�inal
<br /> Gas Pi in Boiler Lavat ash Basin Drinkin Fountain
<br /> Water Heater Refri eration Shower Flaor Drain
<br /> Gas Firepiace Wood Stove Kitchen Sink&Dis sai Grease Tra
<br /> Gas Ran e Ductin Dishwasher Roof Dreins
<br /> Clothes D er Hooku s Ofher: Clothes Washer Medicai Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink Service/BarlMo etc. Other:
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<br /> Chemical or Water No.of Meads
<br /> ACKNOWLEqGEMEM:•I have reviewed this application and canllim the iniamation cantained herein is tnie and correcL Wo�lc done pursuant to thls permit must compJy wiJh
<br /> current federaf,stete,attd focal law.The granting of a permlt on(y authorizss approved work artd no devfaUons therelrom.Dev/atlons must flrst be aufhorfzed In wrldng from fhe
<br /> Building Oflfclal before 6eing authorized under any cTicumstance.!sm fhe owner,or!am authorized by the owner oflhls property to perform the work for which applicallon is made,
<br /> and I compty with the State Contrectors Lew t 8.27 RCW and 29G 200A WAC.
<br /> City of Everetf Ofh'ciaf Use Only
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<br /> �� PERMIT � � �
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<br /> Owner Authorize Agent Signature Date (Revised 9/3/2018)
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