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<br /> PERMIT APPLICATION
<br /> BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> '41116.0r ' 3200 CEDAR STREET.EVERETT.WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 j(E)everetteps( everettwa.gov j www.everettwa.gov/perrnits
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<br /> PROJECT SITE ADDRESS: i Ci i 3 pi ri st 11 ttrst fill-C. PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: -I-h-e,resc.: (I ) yr--re-C__ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET i g i 5 13)n-eh U,S-i- ) l) _
<br /> CITY gi1_e..4,--e el STATE ttlet ZIP q gl-..2-e9 3
<br /> OWNER PHONE: -0; • 9453- 2--?-‘0,0, OWNER EMAIL:
<br /> CONTRACTOR NAME: rirreist-yzoil 14e ez:+7 n ç 4
<br /> CONTRACTOR ADDRESS: STREE, 4( 7 i -7a:::Lsf--fr_ _pf -/ jaf..
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<br /> CITY.- ,,a10A 1 A 4rsir Vi 1 tt ,STATE
<br /> CONTRACTOR PHONE: 300 -3 gel)-q gi q CONTRACTOR EMAIL: rier-ret6i-Mlihri 4)02mcg 51,aim
<br /> CONTRACTOR LICENSE AREQUIRED)0 r4$17611', f4-1)a) CITY OF EVERETT BUSINESS LICENSE ItIREOUIREDO iii)----iii/
<br /> PRIMARY CONTACT: DOWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONii
<br /> CONT T NAME: , CONTACT PHONE: 2 ) —3 go, _gg-,1 q
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<br /> EMAIL://ley-ei 5,t1'7iThi.,,,,a 6619 ill c&0,2t±Asitt000tosin*ot:4v::::#04v:,7 -,frf: ,-,--- ',.!'''''.:•?"':'qiit--:1',1; ;-:::: ::';',;
<br /> Existing Use of Building: Contract Price of Work:$ ;(;1.---) g ,JO 0
<br /> Proposed Use of Building: Heat Source: .448as 0Electric ElOther
<br /> Building Type: 3AFR-Detached OSFIR-Attached E3Duplex alvIulti-Family-#of Units: 0Comrnercial aindustrial
<br /> Type of Project: ONew ElAddition ORemodelPif tepair DT.I. 0Sign 0SprinIder 0Demolition 0Change of Use
<br /> DESCRIPTION OF WORK:
<br /> .../.
<br /> At.„„y klac.e, K la eamuz-t-r---
<br /> I n kind ' P
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICALi0000**000:***(:'c'::: :, ,-,;:',:,.:: ::-:::;',.;‘::1:::::),--,-SOOkittii.t*RO1trAlft.**0001:',!;":.'1:,-;- :,--,H:,
<br /> Type of Project: _New Addn Alteration _Repair Type of Project: New _Addn Alteration Repair
<br /> Fixtures Fixtures List List of Fixtures . List of Fixtures List of Fixtures List of Fixtures
<br /> Frxtures xtuof res
<br /> A/C-Air Handling Units Heat.Pump Toilet Backflow PreVenter(Inside Bldg)
<br /> IForced 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 /> ,
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other.
<br /> ..R''::( #11,004-10l: **lilt*::•:ff.:2.
<br /> -Chemical or Water 1 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 /> affront federal,state,and local law,The granting of a permit only authorizes approved work and no deviations therefrom.Deviatkers must first be authorized in writing hem the
<br /> Building Official before being authorized under any circumstance.lam 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 Contractors Law 18,27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ittr)64/14/1-A- zit -.24 - ic( PER 1 #
<br /> hylA v(604,- O6
<br /> Owner/Authorized Agent Signature Date (Revise 9123/2016)
<br />
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