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PERMIT APPLICATION <br /> 001111111111,—, BUILDING/MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX425-257-8857 1(E)everetteps@everettwa.gov.1 w.wweverettwa.gov/permits <br /> or Waal'tifiiiTinPROJEMSI IPIFO ... • <br /> PROJECT SITE ADDRESS: Ltei_ 4'1 ! iV e 1.0PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> COINTA TOO Vit .. <br /> OWNER NAME: 1 t TENANT NAME(If ommercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CnY •may STATE '1 0 Z!P q :II9 t.�Z,J <br /> OWNER PHONE: L4 - ) I LP OWNER EMAIL: <br /> CONTRACTOR NAME: G .+yos, -e .= - 4 <br /> CONTRACTOR ADDRESS: STREET 1–r"") <br /> CITY / GL- Y STATE A ZIP 4 '' L <br /> CONTRACTOR PHONE: ,)-c- '3 Oji 001.01 ICONTRAGTOR EMAIL: + <br /> CONTRACTOR LICENSE#(REQUIRED): Y" `? 4 a!`! k)JCITY OF EVERETT BUSINESS LICENSE#(REQUIRED).! , `71 1 <br /> PRIMARY CONTACT: . <br /> Ci OWNNER 13ANTRACTCiR 1:1 OTHER(Please Specify)...... <br /> CONTACT NAM CONTACT PHONE: l - {1 0 g <br /> '" <br /> � G L CONTACT EMAIL: n( -' j'U�Y'�Ir ? C , <br /> LDIItN#I`I PE T APP! CATIO* <br /> Existing Use of Building: Contract Price of Work:'$ d 49 r <br /> Proposed Use of Building: Heat Source: CIGas 0Electric . ❑Other <br /> Building Type: DSFR-Detached C R-Attached ElDuplex ❑Multi-Family-#of Units: 0J Commercial. Dlndustrial <br /> Type of Project Mew I]Addition ©Remodel Repair OT.i. ©Sign OSprinkler E3Demolition IJChange of Use <br /> DESCRIPTION OF WORK: f t ,1C " <br /> ASSOCIATED BUILDING PERMIT# if a••licable: <br /> MI1 lCA1 P' 1 ;*UU kT ON -PLAINIO00 —kalillr0 ► 4 � <br /> Type of Project: _TNew Addn _Alteretlon -_,;Repair Type of Project: New _Addn _Alteration Repair <br /> #of ;List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Reffrigeration. 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 /> 'Chemical or Water I JNo.of Heads <br /> ACKNOWLEDGEMENT I have reviewed this application and arm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and focal 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.lam the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> ^1, City of Everett Official Use Only <br /> PERM yin <br /> OwnertAuthorized Agent Signature Date (Revised 9123/2016) <br />