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PERMIT;APPLICATION
<br /> Bl1(LDI MECHANICAL I PLUMBING I SIG fRINKLER!DEMOLITION^ ' ` III I�,/� CITY OF EVERE I I PERMIT SERVI ��' ' = 3200 CEDAR STREET,EVERETT,WA
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SiTE ADDRESS: ' f PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision 'if-, �'r Ave. Lot No. (attach copy of long legal description)
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<br /> _OWNER NAME: EVE e E T u t Q v Wit& TENANT NAME(If Commercial): '1471-61-Do t J b _/.i
<br /> OWNER MAILING ADDRESS: smear 7[ •a i E.0 x. 1 Sc-if , ` n
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<br /> cn :- EJ I_ STATE Li - tiP B2 O(9 /S-Y
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Pl_1.-I E 40 `O..4 c h c_v{1.- !
<br /> CONTRACTOR ADDRESS: srtzEET c `Z.0 `y H-ew , 1 i Ave v£ C��T �1 CocrrY C -,-i--\- STATE L�P1- ZIP t U Z.V C
<br /> CON •- --• • : CONTRACT°. AiL: �7
<br /> F EVERETT BUSINES..LICENSE#(REQUIRED):a'�(2j/ ?
<br /> ONTRACTOR LICENSE#(RE(2.U1'-r): R�1,1EGh t�b� TY O
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<br /> P. =RY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Spe 'It) b
<br /> CONTACT NAME: CONTACT PHONE: 7_5---- Cj - t(0 ( 4' -
<br /> i '—,`.\ vim) Li, ,J ([.LI_ CONTACT EMAIL: (62.,n( 1/�f\f k4 • Q 4---421
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<br /> Existing Use of Building: A.0 L.✓ , ^-'� A rh t ontract Price of Work:$ q.Oi l/0
<br /> Proposed Use of Building: Heat Source: CIGas DElectric DOther
<br /> Building Type: DSFR-Detached I:SFR-Attached DDuplex DMultl-Family-#of Units: CIC4mmercial Chindustrial
<br /> Type of Project: I:New [Addition IjRemodel DRepair DT:I. I:Sign I:Sprinkler I Demolition [Change of Use
<br /> DESCRIPTION OF WORK: t a a SI NS
<br /> \e -ce.-. C�Dm� yr c , ,_, L,..) i 1-},nti-
<br /> re_Neti L r' E nt_. Sl-rir.,t I -5 ,5' ,Feer e d
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> i E+ '.HA 1 0 `i? #101`:5401.9110 rit. l) ,': .• .- .PLUtitfra i40.PERMIT:AP'Pi iCA-TIO'N, '
<br /> Type of Project: New•_ Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> #of #of #of List of Fixtures #of List of Fixtures
<br /> List of Fixtures List of Fixtures Fixtures
<br /> Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub .-I 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 /> Number of Heads
<br /> ACKNOWLEDGEMENT:1 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.1 am the owner,or 1 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 City of Everett Official Use Only
<br /> Zi � 0/92/20155OwnerlAufhorientignafure (Revised 9 1
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