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III PERMIT APPLICATION
<br /> r' BUILDII I MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> u e lr, .. E nl `es 1 Q, 4 MATIQN_ ._. T,-'-VaittE
<br /> PROJECT SITE ADDRESS:7,1 'C Gefe btJ Je+ ', Wi g'2O ( PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> *,owg.I () E �„€E .>s ,.,, Ni 21V
<br /> OWNER NAME:6(0 /T2ct(N. Coo f'2.(st f i(/p o4 Pel; 'OI,cAATENANT NAME(If Commercial):aro e"rii, coor4„f,ye/cm
<br /> OWNER MAILING ADDRESS: STREET Q
<br /> CITY e/L.f i(e STATE ZIP I (2 f
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: relt�r(�,� Pre; IN c 1
<br /> CONTRACTOR ADDRESS: STREET f� I SO�. F7�- ce j gee 2 r
<br /> CITY STATE 196 6 ZIP q$' OR
<br /> CONTRACTOR PHONE: ( . P) 73 2- gStq CONTRACTOR EMAIL: IIekf4CO
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<br /> CONTRACTOR LICENSE#(REQUIRED) Cpvt. FT 2_1
<br /> n1 6
<br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C I,j g(12.1
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<br /> PRIMARY CONTACT: 0 OWNER KCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: S au. Lapp CONTACT PHONE: (2 v6) 2.32- gS.B q
<br /> CONTACT EMAIL: g fil�c I Col j � i Ire � f
<br /> Existing Use of Building: IYosp;/u/ Contract Price of Work:$ 2,200
<br /> Proposed Use of Building: tic c to fiat Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: *Commercial ❑Industrial
<br /> Type of Project: CI New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign jg.Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: N Fe Q 13 TI Wef c i fY1.
<br /> p1 v\K(er Heal 3 Re 10 Cd f 2
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> Type of Project: _New _ Addn _Alteration _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 /> A/C—Air Handling Units —Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air S stems —Unit Heater Bathtub Urinal
<br /> Gas Piping —Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater —Refri.eration Shower Floor Drain
<br /> Gas Fireplace —Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range —Ducting Dishwasher Roof Drains
<br /> Clothes D er Hookups —Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> 0;R11 :4X*I U,ry:.F S :P.Mr,: e
<br /> 1 Number of Heads
<br /> ACKNOWLEDGEMENT:I 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.I am the owner,or l 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.
<br /> City of Everett Official Use Only
<br /> O/2Z/'ZO 11 PERMIT# /
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<br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016)
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