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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> a <br /> x,54 & - a4.� 71::--- - Pq i pr-in`,-;:e];�,- js` <br /> S 7 <br /> PROJECT SITE ADDRESS: IOW it Oa l 7T AVe PROPERTY TAX#: Q) ^ g.l 25/2.0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 0 r : E + ., F na <br /> OWNER NAME: 15 V eke 1 Pu,BL.1 C 14G1/1IES TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .1660 W//T A Ve-- , SUITE o c <br /> CITY 6 y e RG STATE UM- ZIP 9 'g2 bl <br /> OWNER PHONE: 4/25—'3 ZZ' 2..bO OWNER EMAIL: rnQt.k C 1 of le 2 2 COrt4La51- 0a.COr.C,©-t.4 <br /> CONTRACTOR NAME: 5'131) . Ex C AVA 1'I DN <br /> CONTRACTOR ADDRESS: STREET 4‘,358�( (2)7 AIie • N6 D <br /> CITY R6Dirr YOB p�Y b STATE WA ZIP 06,53 <br /> CONTRACTOR PHONE: Li ZS—-148 I Lt(3 CONTRACTOR EMAIL: CoA-}-ad- •1 big e) &V0.-1-JBAJ .iir, <br /> CONTRACTOR LICENSE#(REQUIRED): JOHNS SDO ANN K CITY OF EVERETT BUSINESS LICENSE#(REQUIR • : L 1 ?itT <br /> PRIMARY CONTACT: A OWNER 0 CONTRACTOR 0 OTHER(Please Specify) realerl ' <br /> CONTACT NAME: CONTACT PHONE: 7,6----3 2 z - z6 <br /> M/NZI4 C,L4 R,e-._ CONTACTEMAIL: > 44...y... .. el cvr k 2 Con,4casts3r -aded-,Com <br /> S <br /> Existing Use of Building: Contract Price of Work:$ t t`Q W. °' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: 0 Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: R toV $ R691.46.6 Fit)ay BAc.K FLOvte DEV)66 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): be/N. <br /> -i z4° +f dl yi 39 `fir <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air Handling Units —Heat Pump —Toilet Er'Backflow Preventer - '-- - J g) <br /> Forced Air Systems —Unit Heater —Bathtub LEMMINE52R <br /> Gas Piping —Boiler —Lavatory(Wash Basin) —Drinking Fount-in <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 /> Chemical or Water _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 298.200A WAC. <br /> City of Everett Official Use Only <br /> 714 A^1174 r PERMIT#A,4r S-Ll-goI5 l(60 . <br /> Owner/Authorized Agent Signature Date (Revised 9/23)2016) <br />