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-.,: <br /> PERMIT APPLI owns N <br /> f UILDI G./M CHA.NICAL/PLUMBING I ����� /SPRINKLER/DEMOLITION <br /> -,e-.-"` CITY OF'EVERIZ I! PERMI SERVICES <br /> " T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)•425 257-8810 I FAX 425-257-8857 1(E)everetteps@everefiwa.gov I www.evereftwa.govlpermifs <br /> (01.4'.0 E Iiic )n b>tal[ P Ise PL 0c.T*At-Il friNilifiWi li N. • - <br /> PROJECT SITE ADDRESS 2 (fat trim "" PROPFti7 Y TAX# <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> • t. ..,- F.. . .PONTAcT[1*!.ff MATION • <br /> OWNER NAME: c- „J ."f-- // TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET• ,1( ( 1 z.. < e...a a A'Ge 461-- <br /> Crory ZE / STATE km . ZIP <br /> OWNER PHONE6-/zc--) Z5-S —f,‘?.,._..,.. .., OWNER EMAiL: <br /> _ •i <br /> CONTRACTOR NAME: ( 9--.--:1. . r .+', C' <br /> CONTRACTOR ADDRESS: STREET .t 2.0 A-(1,- LC <br /> CoyC2-t-r STATE LA.;R ZIP 61 V ( <br /> CONTRACTOR PHONE: f425) 1-$2,- St(t± CONTRACTOR EMAIL: 12 .4... . Wi(k.)i,,.--C` L'f <br /> CONTRACTOR LICENSE tt(f SQUIRED) GuGizessE '7 • CiTY OF EVERETT BUSINESS LICENSE*(REQUIRED): q} 5d <br /> PRIMARY CONTACT: °OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:� (i. ZS) 5c,g—07Z, <br /> -i i f..3 G CONTACT EMAIL: \ LA. J a 6', j'3'If.£ sL-61in <br /> -:laluiiLfiri41G OtitM><r APeWAT><®» • :. ...: .. , -...-:-. •.. ,..: •. <br /> Existing Use of Building: Contract Price of Work:$ 1 <br /> Proposed Use of Building: Heat Source: °Gas VI-Electric ❑Other <br /> Building Type: °SFR-Detached QSFRAttached DIDuplex DMulti-Family4ofUnits: Commercial °industrial, <br /> Type of Project: ONew °Addition °Remodel ❑Repair On ❑Sign °Sprinkler °Demolition !°Change of Use • <br /> DESCRIPTION OF WORK: r4xx 5V i. 4,1520t.6.4.- + 61641-" S f 1 `eu....•e to -14,40 1 4440i. <br /> t,..=7 t k * tetA3 G'+ :.p 46413?-1 L-lle(t 1 t-h (r pv t1 ,..ibEr loorizep Aii,s clizawd <br /> twin.-bre .strunAme <br /> ASSOCIATED BUILDING PERMIT#(if applicable): --- <br /> .. .. .:..Il c114AF AL 0i0At At.60:1004OPI : - . PLU,I .1.1\16 PMTAP 4)0Afi(O ' <br /> Type of Project: r New._ Addn _Alteration Repair 1 Type of Project: New Addn Alteration Repair <br /> *of <br /> #,of List of Fixtures #0! <br /> List of Fixtures , #or List of Fixtures hist of Fixtures <br /> Fixtures Fixtures Fixtures ; Fixtures <br /> NC-Air Handling Units G Heat Pump Toilet Backflow Preventer(Inside Bldg). <br /> Forced Air Systems Unit Heater Bathtub 1 Urinal <br /> Gas Piping Boiler • Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration ! ShowerFloor 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(8eryiceiBar/Mop(ete,); Other . <br /> -Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informs€ion contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,end 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.tam the owner,or l am authorized by the owner of this property to perform the work for which application is made,. <br /> and/comply with the State Contractors Law 18,27 RG W and 298.200A WAG <br /> City of Everett Official Use Onlytk,.../i.e....,c,et,, c,..... ei, <br /> PERMIT* • <br /> s_,, (0 <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />