|
PERNii C APPLICATION
<br /> . BUILDID.-OVIEGHANIGAL I PLUMBING 1 SIG RINKLER I DEMOLITION
<br /> ,?4:11w/.,,.77:
<br /> � ;" ClT'bF EVERETT PERMIT SERVITJLU
<br /> 3200 CEDAR STRLET,EVERETT,WA 98201
<br /> (P)425-257-88110 I• FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/perrntts
<br /> 0Y V-rY-JIFF:,YKEV kV1@51T6.®0t';.,, tF t t
<br /> PROJECT SITE ADDRESS: PROPERTY-TAX#:
<br /> 1/31 R,4(0/E0 A1105 iiUE0Y/T Iv'', 9b'..-oi 9-90, (')l t t k> 2D0
<br /> LEGAL for new construction: Short Plat/subdivisiony�7Y 4//�+. Lot No. (attach copy of long legal description)
<br /> , . --- C. - .. ,. . C©i4[TAli ,-FOFiltliT 4.0. '-•...:•':„c:''...-?;'11--1,•:."..'-.'
<br /> �.-, .'".-`'.'7''':.'.'
<br /> , - .-.-,-.1):...'.-
<br /> OWNER NAME: 5 v 77- Hor:+'S/.JGLr! `©/ltT 1 ENAt�IT NAM)v;(If Cornmercial): �i -`NtX.t.GLl1V`-
<br /> OWNR.IVlAILING ADDRESS: STREET .10 (7,,,g�c. t 4.t:
<br /> CITY 5v ,. STATE 44.--A.11 ZIP 992.0/
<br /> OWNER PHONE: .— 23.V -Gfpl b OWNER EMAIL: },'�C,!-1 Y EVM4•c5)20
<br /> CONTRACTOR NAME: /9-,(,)-1,-p Cr.S r,<.�'.c�?'4.tc-Tr(. AS5-49Ctel-7:47.$' .: . '=A1
<br /> CONTRACTOR ADDRESS: sine r 3 J 2 r e4/ r¢G_1==: Q,
<br /> G1TY' ,�G-'���f7' Sri1TS
<br /> I'f ZIP f''b'a` 0
<br /> CONTRACTOR PHONE: '/2r. 2 5 cr'~-(oci-- CONTRACTOR EMAIL: :ifD 33 4&4 711..4.tegvr? srRI(Crrv.J.w T
<br /> CONTRACTOR LICENSE#(RE TIRED)_CG�411i,r nerf5 PA:- Girt OI EVERETT BUSINESS LICENSE#(REQUIRED):O3 76.oZ 2
<br /> PRIMARY CONTACT: J__11'1--OWNER ❑'CONTRACTOR: II OTHER(please Specify),
<br /> CONTACT NAME: CONTACT PHONE: 4/2. ""' ?_.3,63 — /-7/c.9,,, .
<br /> j62) ti/ikti .- (ivti--i-1).. CONTACT EMAIL )-#,E tJ=U r U//, - . c:).1
<br /> ..? : ,.BUH OJ,NG�'PE1R'.Mt.cAPP-LIICATIO[
<br /> _ ''
<br /> g Use of Building: St", �!©fi; f-/r.'S`/,ti:3_G 'f� rr �.? " 'Contract Price.of Work:$ _'..-/•,W•-,/,44) 0
<br /> Existln
<br /> Proposed Use of Building: A77{.�-7 it..S Heat Source: OGas. IlfErectric QOther
<br /> 1Building Type: USER-Detached QSFR-Attached ci Duplex I Multi-Family-of Units: S- W mmercial QIndustrial
<br /> Type of Project: ONew QAddition ElRemodel EIRepalr` QT.!. 0Sign OSprinkler ❑Demolition 0Change of Use
<br /> DESCRIPTION OF WORK: 1�acs t G -- .... $"•-•,-R acrd ._ - 7 4-R; d, -,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> •M MEIiIiElaillCALPE it1±t17APPPLI+AfIbN i , - - P1:tlit DHG PP13?MfiTAiiiiUegilt5N
<br /> Repair Type of Pro New _,Addn Alteration _Repair
<br /> Type of Project: _New.� Addn Alteration Project:,;-,_• g }
<br /> #hof #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures: List of Fixtures
<br /> Fixtures' Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow•Preventer(Inside Bldg)
<br /> Forced-Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Baiter 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 Iiliedical.Gas
<br /> Range Hood Water.Heater _Other
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPR[N. iLg:1 I,§:0-00 SSY04, 1f'S;t'I M.•,....,._
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT!have reviewed this applloatton and cOnfir'm the.inforrnation.contained herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,stato,and local law, The`granting of a pannit only authorizesapproved work and no therefrom.Deviations must first bearrthorized In writing from the
<br /> Building Official before being authorized under any circumstance tam the owner,of•l amauthorized by the owner of this property'too:perform the work for:which application is made,
<br /> and/co defy with the State Contractors Law 18,27RCwand 296.2001A WAC.
<br /> 1City of'Evenat Official Use Only
<br /> //‘
<br /> PERMITlb#
<br /> 1 S0
<br /> Own er/Authorized Agent Signature Date (Revised 10/12/20166)
<br />
|