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PERMIT APPLICATION
<br /> BUILDING /MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br /> /11P1/00‘% --4 CITY OF EVERETT PERMIT SERVICES
<br /> ' -7 ' 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue+,d'tr,B1 iftIOSIV fie* V.s,.' .. +'r'> *l..x', ..._ ► * , u,:�. .. t
<br /> PROJECT SITE ADDRESS: 3 7a( , 3 r'n4.426-042:1 SW:! 10 e PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME: /4 P Q &a,-te waJ N £.k - LLC. TENANT NAME(If Commercial):0/44,n.; Co 4r&c— 1Sa I uji tst,t,N
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 0A,,v.,: (...‹,,,,-4-r4..c,4it, SoIw1-t=-,5 U--C--
<br /> CONTRACTOR
<br /> __.CONTRACTOR ADDRESS: STREET 372(,Qr �13row/4(,yrjw
<br /> cy ..(-c 3 a I Q i
<br /> CITY E�,nL{.'4 J STATE If ZIP /04:10 `
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<br /> CONTRACTOR PHONE: 4�.5--- (a( 7- .(q(e ( CONTRACTOR EMAIL: Javitt. C,A,,t,,,;co6,,krc..4: St(kt'-i�`,-S.Levt,.
<br /> CONTRACTOR LICENSE#(REQUIRED):d/14 UZ 5(V 1 Ak CITY OF EVERETT BUSINESS LICENSE#(RQU
<br /> EIR.):=?1
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: 3–ct.trej Sko(".( CONTACT PHONE: •.:(� 3a'7- € S
<br /> CONTACT EMAIL:.: ,�ayy,,�� xia`ree q`7 p rn.W i Co miskA Tf )J(75c 1,�. 1°`.$.00A-k
<br /> z `°S;-S'� "`�t - `6fillt ems..0-'' Elk.5 �. . trO ., N ` " .44:4- �` ; ` .,_
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<br /> Existing Use of Building: p.�';e.c./Q.e, .; l 4�f I-ntract Price of Work:$ SDI *Of)
<br /> Proposed Use of Building: Q. ;c._ Heat Source: XGas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units:_ $Commercial El Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair pH. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ,4 dote 1 11.4•Fay'1 a,r %AP 4 is 4t.t.,.1 Cry 1'q r ,ro 2.Nc ,1,11•
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> u /+ w � /► �r � ■ {e' � "e xs��- a, '�Y �'" y�yyw ';`' � � � 4
<br /> . ' -:••!tlit 701 1001:01.s..,,.� 10:4 .°"'r.; "ea :,r is:4�+a DUMB, i .b a %/!�,�f?.DAC t �a...sti....,y m
<br /> Type of Project: _New _ Addn Alteration Repair Type of Project: _New Addn Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C–Air Handling Units 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 /> Exhaust Fan —Sink(Service/Bar/Mop/etc.)—Other:
<br /> SPRINKL'Eltf SUPPRESSION SYSTEM:
<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.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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> /, j City of Everett Official Use Only
<br /> �o�1 ( o2f7) PERMIT# �1-1(063'4
<br /> Ownlit/51
<br /> ed Agent Signature Date (Revised 9/23/2016)
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