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PERMIT.APPLIC.ATIO <br /> ,d_,---%, = BUILDING/1VMECI.IANICAL/PLUMBING 1 SIGN/SPRINKLER/DEMOLITION <br /> ! mss" CITY OF EVERETT PERMIT SERVICES <br /> "� ''' `, - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8867 1(E)everetteps@everettwa.gov I www.everettwagov/permits <br /> IC61.0i.0 1 9 i4 fic h ii.Ani<)Pieaso) . .. 0:0310,CT II ' I IFORM 7If0t r.. . ' . • • , .. ; 7..:,...:....: <br /> PROJECT SITE ADDRESS: q k//Met-.772PROPERTY TAX##: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ;:::7... <br /> , .. r .. ,... ,ter g .. .. ,. <br /> OWNER NAME: iii11,8 el 7 ' TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET y ,`05 L4I//1 t' &I, f� <br /> cm! �yE+i STATE s ZIP C (/ <br /> OWNER PHONE: C2,490., iq...---4t2/,,. ..... .., OWNER EMAIL:... . . <br /> CONTRACTOR NAME: 7 Ma1.7 I4( 1 A6' <br /> CONTRACTOR ADDRESS: STREET 2..t Z0 P cg,e- <br /> CITY STATE W* ZIP eiV2.0 t <br /> CONTRACTOR PHONE: (LF25-) *2-52...- ,5 I(t-t- CONTRACTOR EMAIL: (-2-CJ.-1 .0 .>g.. WI(4JCB..,cool11t <br /> CONTRACTOR LICENSE#(REQUIRED): evErLe s p-;7 p-r--- • rITY OP EVERETT BUSINESS LICENSE#(REQUIRED): 00.:, lj cj <br /> ay.pw.oeww.ixxin+.-•cwsJ+wwxVwwnY+t4w+Mq,�� »auuxga...as+xr.rnr +xv+r,a.uwnrnr•.'rg*q�naw s®exw.�tw..ux...y.m..Y•TrY•'Yrevu.....w+cr....wM..vrf+.wrr.sm.rvw�..++rnv <br /> PRIMARY CONTACT: El OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ((its) 5©1—07 <br /> 12-G---( ) i..-it:i CONTACT EMAIL: j AA--4 p 55/`YIwor...6,e't <br /> ...*...;;;-‘21::....: :. ' . • .. • -OE Uiil DING.PI R[ill1T;APPLICATIei • " . • ;.••.• .. ... <br /> // <br /> Existing Use of Building: Contract Price of Work:$ 4 a71 19 . <br /> I. <br /> -Proposed Use of Building: Heat Source: ❑GasItElectric ClOther <br /> Building Type: I FR-Detached CISFR Attached ❑Duplex CIMulti-Family-#of Units: ElCommercial Cllndustrial. <br /> Type of Project: ❑New CIAddition ElRemodel QRepair )�T.l. OSign ❑Sprinkler ❑Demolition ClChange of Use • <br /> DESCRIPTION OF WORK: <br /> :iC"vrA't- (biz -, , S t'f610 "5.(t S44614. <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> r:..::..MACH,A llcAlt::PERM LT' PLJCA` IO I • . -. '•'. . P LU iDAING Calgi it...40.0 fC.1i3OH <br /> Type of Project: New Addn Alteration _Repair , Type of Project: •_,_New Addn Alteration Repair <br /> °fList of.Fixtures of List of Fixtures °f <br /> List of Fixtures <br /> I #°f List ofi Fixtures <br /> Fixtures Fixtures Fixtures Fixtures ' <br /> A/C—Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg) i <br /> Forced 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 i Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: - Clothes Washer Medical Gas <br /> Range Hood Water Heater I Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> Number of Heads I <br /> ACKNOWLEDGEMENT/have reviewed this application and confirm the information contained herein Is(me 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.lam the owner,ori am authorized by the owner of this property to perform the work for which application Is made, <br /> end/comply with the Stat Contractors La 27 RCW and 296,200A WAC. <br /> City of Everett Official Use Only <br /> / <br /> eiZ✓ 1:- —17 7 PERMIT )----1(J y� (0....... <br /> 0,1 q <br /> Owner/Authorized Agent Signature Date (Revised 520/2016) • <br /> 1 <br />