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PERMIT
<br /> 4BUILDING/MECHANICAL I PLUMBING I SIGN 1 SPRINKLER/DEMOLITION
<br /> !y f',y,,z_it, CITY OF EVERETT PERMIT SERVICES
<br /> } r 4� 3200 CEDAR STREET,EVERETT,WA 98201
<br /> .(P)425-257-8810 1 FAX 425-257-8857 j(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> 1 (4;®r C >EaiI4•11uiJl . 61jy ja4. ..6) " , PG ® K 'l l}t' I I1 6g till. •-: . . . • _ 7..,:-.2.•:.•
<br /> LPROJECTSITHADDRESS: %'2 b (317.0A ....14-1-(�C�, PROPERTY TAX r#:
<br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description)
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<br /> . . • .. . :id6161Y`Kel liki#bitiblAtiCig : . • •. • • • ' •.. . . .• . P
<br /> OWNER NAME: IA A ` 765 TENANT NAME(If Commercial): 9i=k6bittilrftWriTS1
<br /> OWNER MAILING ADDRESS: sTREEr V-�
<br /> CITYSTATE ZIP
<br /> OWNER EMAiL:
<br /> OWNERPHONE: ....-.. . .. :..._ .,........,..,. . ,.�,,.:.,. ..�,.,.. ......-_.,.,��-..,..,.,,..
<br /> CONTRACTOR NAME:..,t:701:-:-4. "2 ,_.S Vc � A CONTRACTOR ADDRESS; STREET EZ0 P_ —
<br /> STATE LOA ZIP C !
<br /> cITY ¢=c2
<br /> CONTRACTOR PHONE: t ZS) '152-- ,_(l L CONTRACTOR EMAIL: i=2-6--?-14-6....e:%G,1G<='=Co ril
<br /> CONTRACTOR LICENSE fARERUiRED): �.�•-12. s<so r7 '.ice ............ .1GD .,_.__.,r.....r.,T _....,,,.,..t.EQUI�.�.._ .....—...,H_,.v.._..c<,K..r
<br /> (CITY OP EVERETT BUSINESS LIGENSB#{REQUIRED}:
<br /> PRIMARY CONTACT: Q OWNER %CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ( z.v ,jol'• _0—7Zi
<br /> 1.L0%(-1 CONTACT EMAIL: ` t 4 a 65/77,,,a_..67,74
<br /> .... :- •.•• PLJILDINQ PERMI`y-APPLICATIOJ I .. ..
<br /> ••. �.+ ...-..• .: . •..:... .. . .
<br /> Existing Use of Building:- r f
<br /> Proposed Use of Building: (Heat Source: as QElecfrio . QOther
<br /> Building Type: CISFR-Detached ❑SFR Attached QDuplex ❑M'Confract ulti-Family-�Priee of Uonits:f $ Z�p�, �
<br /> Work: Commercial Et Industrial.
<br /> Type of Project: UNew QAddition QRemodel ORepair QT.!. QSign QSprinkler QDemolition QChange of Use •
<br /> DESCRIPTION OF WORK: 'j t_i___( (� 5 r),v 44--6 ( ...1._ ..T_ K--(t �( 1) 6 7x )
<br /> • 12 rt &
<br /> ASSOCIATED BUILDING PERMIT#(•ifffapplicable):
<br /> ?. • gCIfANuCAL:P; o?ii:T A PUC: TI• .: f- . . • :- Pi IJM AN -PERMIT:APPLIICATII N •
<br /> Type of Project: New Addn Alteration Repair Type of Project: New Mai Alteration •_Repair
<br /> of f of • List of Fixtures
<br /> #f of •
<br /> List of Fixtures #of List ar"Fixtures Fixtures List of Fixtures Fixtures
<br /> Fixtures Fixtures
<br /> Toilet Backflow Preventer(Inside Bldg)
<br /> NC—Air Handling Units • Heat Pump Bathtub Urinal
<br /> Forced Air Systems Unit Heater
<br /> Boiler .1 Lavatory(Wash Basin) Drinking Fountain
<br /> Gas Piping Shower Floor Drain
<br /> Water Heater Refrigeration
<br /> Gas Fireplace Wood Stove ( Kitchen Sink&Disposal Grease Trap
<br /> IDucting Dishwasher . Roof Drains
<br /> Gas Range
<br /> I Clothes Dryer Hookups Other: • Clothes Washer Medical Gas
<br /> Range Hood
<br /> Water Heater Other:
<br /> 3 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> :::,.=7,::.::'.0.i4/00:0 10.0001, j .SYSTEI4Mi•. . ...- .
<br /> 1 Number of Heads I
<br /> tCKNOWLEDGEMENT-`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 /> :urrent 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 /> 3uilding Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perfonn the work for which application is made,
<br /> nd i comply with the State Contractors Law 27 RC W and 296.200A WAC. City of Everett Official Use Only y
<br /> PERMIT#
<br /> IA
<br /> i —3 ..-/ iZ OE — OM ,—......., ,
<br /> Date (Revised 5 0/2016) AH.-/,r»prrd+,th prized Agent Signature ,...•
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