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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SiGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> tfilW4 J" 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 /> -,v�.. ,4. x`� = _r r, E x 4s Rgi .PR9$#tt 'S ' IF iI t tli tititt t111t rM•• -",;•.f,'-74',": ,' :, <br /> PROJECT SITE ADDRESS:/ � l i f-k„'ki/ � N 1ROPERr TAX'it: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ftti5E : " ra' .. ';co zttill*�.QRI A1'io"et t g' e,1 *,.." r IffI <br /> OWNER NAME: TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> ' <br /> etTY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: tz..7" tam P/ ,,,, ,;- . - rha-,h I'+ ,. —e-�' <br /> CONTRACTOR ADDRESS: STREET /.5-47 e1 7 - . /.2 4'.... A,. - S-&— <br /> CITY <br /> s TCITY e.�‘-/0'1- STATE k/ ZIP "i57- .....c.--CP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): y?€' 7~Q PD/74 c5 6-.//ii CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):.2 '6J,6,6 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR CI OTHER(Please Specify) " <br /> CONTACT NAME: <br /> ..ra iei-pi )?mac 7t/._cn CONTACT PHONE: 9„/. y� y <br /> CONTACT EMAIL: TC,3t rfa,t/ e i u'r-'/-exi'GCr,.^r4/wa CO.C <br /> 7.1 s'etitMif-ka V ZI x ` iii,FI, G!, ;ed�il itiii0 iiiitA `*, A 14 5 f., -a a ",T' <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric rlOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: 'Commercial ❑industrial <br /> Type of Project: El New ElAddition ❑Remodel ❑Repair E IT.I. ❑Sign EOSprinkler El Demolition CDChanye of Use <br /> DESCRIPTION OF WORK: <br /> P/t(/ h / ) — .165 a Al 76 i)/7pK// e).-/i e,z <br /> ,ASSOCIATED BUILDING PERMIT .,#,(if applicable): /•7 t5/ —CJ s L <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 r Toilet Backflow Preventer(Inside Bldg <br /> Forced Air Systems Unit Heater F BathtubUrinal <br /> Gas Piping Boiler " ._ii 4 Lavatory. (Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace ,Wood Stove Kitchen Sink&DisposalGrease Trap <br /> Gas Range Ducting ,pishwasher w.- <br /> DRoof Drains <br /> Clothes"Dryer HookupsOther: .... t 'Clothes Washer Medical Gas <br /> Range Hood / Water Heater ;Other, <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.} Other: <br /> i*i RINKI0R!1S A R* i)QNjSYST EI <br /> [Number of Heads i " <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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> ...ply with the State Contractors Law 18,27 RCW and 298,200/1 WAC.. <br /> City of Everett Official Use Only <br /> r PI tMIT <br /> if 9 0 'if' 4///7/11- <br /> • orized agent Signature Date' <br /> (Rev sed fAfl2I2Oi <br />