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PERMIT APPLICATION <br /> "IPBUILDING/MECHANICAL/ PLUMBING/SiGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 ((E)everetteps@everettwa.gov J www.everettwa.govlpermits <br /> ,t <br /> i .. .: _4.,: . .,. ;KIZMEIEMNMNME,PRQJECT SITE'INFORMATI.ON Or, .-.,. _ _...__..-. <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r .. e .:.,oacs. - - r .F.- �''.1 `ii `' <br /> CONTAGT�INFO)ltMA ON: � , ti* , <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> €ONTRACTORNAME: SomYw1 MAW\O (1)4 \Atc 4 i *TAL <br /> CONTRACTOR ADDRESS: STREET 11. ,2 jagm► D. S E ���J�j)�crry 11 STATE WO/ zip QC// <br /> CONTRACTOR PHONE: CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED)501.4 ?}Fib).N/` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ?ja0 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> EerdnagfaataaWeyaZnnlinnfiWfgOjrNOIajtMjt-*kPWCATtj:0:NraatgnrgteigdeIMMESBEeati <br /> D,a-PExisting Use of Building: Contract Price of Work:$ t D 00,°:-.0- <br /> Proposed <br /> roposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition CI Remodel CI Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> go it-ri dol vi m b) 15 -ir (al new 4011-e-7)-5 a rid ( ) new,A 02/01y (s,)i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> VAt IUIECHANIC`AM#M014PP.I:IC,ATIOIi ..,. ` ' rEEP4.UMt31NG)l'ERMITAPPLICATION12.„_,51_. <br /> Type of Project: __New_ Addn Alteration Repair Type of Project: ^New _Addn _Alteration _Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures t <br /> Fixtures Fixtures Fixtures Fixtures I <br /> A/C—Air Handling Units Heat Pump fL Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler ' '7 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 i <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: 1 <br /> k ` Oitif KLER./titik2ESSION *tta , `_;;a 11 <br /> Number of Heads 1ACKNOWLEDGEMENT: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 lam 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 /> City of Everett Official Use Only <br /> a <br /> PERMIT191. <br /> `�' <br /> 0 7 <br /> •';,'Autho m Agent Signature Date (Revised 10/12/2015) <br /> 1 <br /> 1 <br /> , <br />