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PERMIT APPLICATION
<br /> BUILDING/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
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<br /> .4a'.C,•,` y qty. pt _t t _ 711*
<br /> 1 ;1,7:7
<br /> 11,114: 4:64` l , tr'1 :k BE
<br /> PROJECT SITE ADDRESS: 1531 1-64T /4E.. PROPERTY TAX#:OCItt5e0"3 -1LkO
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME: V, ,i regi t rf t /O TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET g+0 di LOA"-
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<br /> CITY EV F"jL
<br /> ir STATE OA"- ZIP g �e,
<br /> OWNER PHONE: Sj 'j 5—q:2//Z9 OWNER EMAIL (�l}ie,(0 ypQ 0./sig I •GQZv1 e
<br /> CONTRACTOR NAME: /; TA, estkEltartaj ,(f 6(Jc,,u, ,
<br /> CONTRACTOR ADDRESS: STREET s s ,t. .- -
<br /> CITY SeA4 Lr/��y��,"`"'��� STATE W4 ZIP cftg107.,.....
<br /> CONTRACTOR PHONE (�'Z„ CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): /1s CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ,QTHER(Please Specify) 61' Crit, roiJWhil)tL-
<br /> CONTACT NAME:* tllwc0.1RA4c., 47 ) CONTACT PHONE: 4Z5---3[S- (,oyg
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<br /> EFF 6rLI-1mop ,�E CONTACT EMAIL: 's G , k Sb-x .1-ord. Ga,4
<br /> Existing Use of Building: 5r14., Contract Price of Work:$40)CL"ID
<br /> Proposed Use of Building: j Heat Source: n Gas ❑Electric ❑Other
<br /> Building Type: 7 FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial
<br /> Type of Project: :New ❑_Addition ❑Remodelepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ,❑Change of Use
<br /> DESCRIPTION OF WORK: P arfe p,�� - .t �5 r '-,,. l,r ; Q ?i rp�,4,f40,p
<br /> Mkt Vi: - Zts'5 \D4t<44EDr, w vl—).�L Z.P� f.rt•OP5/4. S. -"`r'.7go 5
<br /> lb � GPRT � bASSOCI TEBUILDING (if applicable):
<br /> .}+ '0(14
<br /> 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 IIIIIIIIIIIIIIII Heat Pump ( Toilet Backflow Preventer(Inside Bldg)
<br /> 11111111111 Forced Air Systems -Unit Heater ( Bathtub Urinal
<br /> —_Gas Pipin. Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitohen Sink&Disposal Grease Trap
<br /> MEI Gas Range _Ducting l Dishwasher Roof Drains
<br /> •11111111 Clothes Dryer Hookups —Other: f Clothes Washer Medical Gas
<br /> 1.11111 Range Hood IIIIIIIIIIIIIIMIIIIIII ratei`a Other:
<br /> Sink(Service/Bar/Mop/etc.) Other:
<br /> Chemical or Water _No.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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 co ply with the State Contract•s Law 18.27 RCW and 296.200A WAC.
<br /> / ��J� City of Everett Official Use Only
<br /> / PERMIT# n f O f 021
<br /> (140r;,, u• . . . ,,, Signature 'D te� (Revised 9/23/2016)
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