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PERMIT APPLICATION
<br /> -#1111P;—.7,4BUILDING/111114IANICAL/PLUMBING I SIGN/SPRINIali I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov E www.everetiwa.gov/permits
<br /> PROJECT SITE ADDRESS: Stn. ;(k . - PROPERTY TAX#:
<br /> LEGAL for new construction: Short Platisubd€vision Lot No. (attach copy of long legal description)
<br /> ":CWF Oz:ngo-s rg ' '
<br /> OWNER NAME: I ektkil )i r, 1$vtTENANT NAME(If Commercial);
<br /> OWNER MAILING ADDRESS: STREET e gtZ Co 1 kj
<br /> Crry -rte e.4#.42 STATE WA ZtP 4/02.0%
<br /> OWNER PHONE: -2,C-. 1 x"'45. `,005' OWNER EMAIL:
<br /> CONTRACTOR NAME, 1. 31. 12.00 C-t iet j. L.»J,«C,
<br /> CONTRACTOR ADDRESS: STREET (Jo-rz s 74 ' Q A�j
<br /> CITY timtel(1 WAs
<br /> j .vv., STATE A Zip cr 606'5
<br /> CONTRACTOR PHONE: 1.1-4 '232.. 3 1) CONTRACTOR EMAIL: te... te-if`a2 vtt'1" Q,�vla il,c,-+''nevi
<br /> CONTRACTOR LICENSE#(REQUIRED): le, '.g.o Z,Li$ L' j. J CITY OF EVERETTEJBUSINESS LICENSE#((REQUIRED):'�j(o,0 0
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<br /> PRIMARY CONTACT: 0 OWNER 4grCONTRACTOR 0 OTHER(Please Specify) #(pb3 (1, 1 1/IL'
<br /> CONTACT NAME: CONTACT PHONE: '7 ,232- 35700
<br /> 1 i. .- -&.€ CONTACT EMAIL: (G...t*^trot04-ht/h (1 e(Vt,t(fr ,. ✓A
<br /> tip': s s .., .;* ,, .. n 'i !ai c t I A.,' 'a'® ...
<br /> Existing Use of Building: r.e,....TiA.ertc,iit Contract Price of Work:$ '2..4o a 0
<br /> Proposed Use of Building: // eat Source: Deas DElectric °Cather
<br /> Building Type: °SFR-Detached „ SFR-Attached ©Duplex °Multi-Family-#of Units: in Commercial ❑industrial
<br /> Type of Project: CINew ❑Addition C[Remodei Z epair DT.I. °Sign °Sprinkler ODemolijtion °Change of Use
<br /> DESCRIPTION OF WORK:
<br /> y°•cw,eve 5 v'ooCit a kvs, VA ti 1/110 OS t I..VI VA li 46kvtro il-e S 144,v19 1,,o1
<br /> ASSOCIATED BUILD110 PERMIT#(if applicable):
<br /> 3 :.i. ..3 rr#i r_,:. 4St. . rt . , t, A. . . 7. 7. - <
<br /> Type of Project: New Addn ,,,,,,,Alteration Repair Type of Project: New Addn _,Alteration ,.,,.,Repair
<br /> Fixtures List of Fixtures Fix#fr of
<br /> List of Fixtures Fixtures List of Fixtures des List of Fixtures
<br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Goa 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 /> Y
<br /> Chemical or Water . No.of Heads
<br /> ACKNOWLEDGEMENT:i have reviewed this app cation and confirm the information 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 wodi and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.I am the owner,ort am authorized by the owner of this property to perform the work for which application is made,
<br /> arst I comply with the State Contractors Law f8.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> „l V .,...3 W�1 �-t 0 PERMIT.'l P)O I--OL-1
<br /> Owner/Authorized Agent Signature Date (Revised 9!2312016)
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