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elPPERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> �rf 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> �-C�ZS sit tF?�J 12.17Oo <br /> . 37;3-oto l� <br /> �to <br /> -. <br /> LEGAL for new construction: Short Plat/subdivision tL( - 3t{ gt1,&4�a�=ch copy of long legal description) <br /> OWNER NAME: LQ(JISE g .IT TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET . 'Z J / r r <br /> CITY gs2ggf' STATE f!— zip 4'"3 <br /> w <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: XV StONA.. US >IIJC. <br /> CONTRACTOR ADDRESS: STREET 71-.3.s wA' j'Res/IAA) f cm 1--g <br /> owY /�ottouti-Le 1' STATE WA- ZIP ?BO n. <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):isi ST c.I 3-paCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ,--0441.4)— <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR THER(Please Specify) lj <br /> CONTACT NAME/ LJ(S-r-r:tCX.1g 4( - 4 12.0.O CONTACT PHONE: Lit 5---"3m—loin <br /> �� LA--i LI/JD SCONTACT EMAIL: Sv" oai=kk 'f et.) tA)•t /.&V <br /> t <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: .5pg. Heat Source: , as ❑Electric ❑Other <br /> Building Type: ]FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial DIndustrial <br /> Type of Project: ❑New °Addition °Remodel pair DT.I. CISign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Pt.6020 .0F�fwr ➢� �NPo0-�zxt1a% 3 cL- ? m `l`aJsS cog_jzEP(-..Ai, rp,4i(,4 P I /uAit.)Iw SWl— <br /> ' ` W "�'-S `tom "Telt r•�--. cies. <br /> AS OCIAT p BUIL IN M #(if applicable): <br /> ` .. 1 <br /> Type of Project: _New _Addn _Alteration >epair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> allilll A/C—Air Handling Units 111111111 Heat Pump 1... Toilet Backflow Preventer(Inside Bldg) <br /> W'Forced Air Systems 1111111111111 1 Bathtub Urinal • <br /> MIN Gas Piping MI=Boiler 7i Lavatory(Wash Basin) Drinking Fountain <br /> NMI Water Heater Refrigeration Shower Floor Drairi <br /> Gas Fireplace Wood Stove t Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin• l Dishwasher • Roof Drains <br /> M'Clothes Dryer Hookups —Other. l Clothes Washer Medical Gas <br /> Mr Ran.e Hood 111 ( Water Heater Other: <br /> 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• icial 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 l co •ly with the State Contra`•�•rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �� �4� PE T <br /> ._Aq.0q .....02“ <br /> • * i j•nt Signature Date (Revised 9/23/2016) <br />