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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> I'�'4 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Bluetttj4:ki nkOr 1y Please)f r t Pfi„D*Ti SIT I;NEQ__R_ Mgt'10*nuc Sr `" , v y, <br /> PROJECT SITE ADDRESS:7�7Eur izEFvEkarr/tot 6,4 Why PROPERTY TAX#:geosoigo,2o3700j <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> IaW : Q<60aA; n " tN.I „ AOtW7 HO <Of�..N - _ . Ix ' <br /> . <br /> OWNER NAME: YJfecr iaz TENANT NAME(If Commercial): IOC Ay, <br /> OWNER MAILING ADDRESS: STREET 5OJS b o&- 5--, // <br /> CITY V g4EZ f STATE Vic ZIP 9:6203 <br /> OWNER PHONE OWNER EMAIL. <br /> CONTRACTOR NAME: via, v ai et, IA,c) <br /> CONTRACTOR ADDRESS: STREET 011 bo S, ib ,‘r <br /> CITY STATE VitA'.. ZIP g g'o I <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' ,k <br /> CONTRACTOR LICENSE#(REQUIRED) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) y to <br /> PRIMARY CONTACT: K° WNER � F CONTRACTOR LIOTHER(Please Specify) ���„ICAi 'P'�a� � � � ��` � <br /> CONTACT NAME: PAUL— 00061,NA5, CONTACT PHONE: (495) 2./52 <br /> CONTACT EMAIL:!rvp s.Mper.14 Amt �\ACYL*' ayiAi <br /> , § tgHnellielro OM , 4,*ft Nld *T.OiilL:.5a4S <br /> r <br /> Existing Use of Building: Contract Price of Work:$ 35k. <br /> 1 <br /> Proposed Use of Building: Heat Source: Ias it lectricE ther <br /> Building Type: H.FR-Detached MFR-Attached NIPuplex ulti-Family-#of Units: commercial Rndustrial <br /> Type of Project: N ew N ddition U'emodel UT'epair (F ign ITaprinkler W6emolition Rashange of Use <br /> DESCRIPTION OF.WO <br /> "rattA 5 ill crv► 0e0 ASS ECLA64k 3) PI CCLLA Pe= (20-• .E 06 w c <br /> 41-6244e” e'6 deal( 6J sA Co,,,vipG,ta ??e4f t...•-s.. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> „ ' MEGHANIGALLPERMIT 00-4. ATIO1MIUMMTKUMB I PERMITiA+v14.{IC,ATI,ON, . `t xRim <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 /> SSPRINKLER/SUPPRESSION SYSTEM y <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 /> Pa2— <br /> City of EveretttOfficialUse Only <br /> PERMIT#10/d`-2/17 <br /> 97l1IOOLL?7 . <br /> Owner/Authorized Agent ign Lure Date (Revised 9/23/2016) <br />