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PERMIT APPLICATI <br /> /� BUILDIN-IECHANICAL/PLUMBING/SIG1� RINKLER/DEMOLITION <br /> �"�+' CITY OF EVERETT PERMIT SERVICES <br /> ,iiiiJ J <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 /> -.moi. "ttfltiitil $ <br /> PROJECT SITE ADDRESS: P.7.-.)?2-4 I 4 t, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No.(2._(attach copy of long legal description) <br /> "._ . MMna _ O N �� r <br /> 'OWNER NAME: Mc-t-c--t G ?-i cL, • f- (Y os TENANT NAME(If Commercial): <br /> DWNER MAILING ADDRESS: STREET tl.c/-a k\ ctoe6 j j'\A Y , <br /> CITY 50-k V l �t t'v `'�, ^� <br /> q �� STATE V.111741 ZIP(1�I !� <br /> Q4ER PHONE: `''t $- 4'S ?1-4 q I OWNER EMAIL. I <br /> CONTRACTOR NAME: Wec;1"-- C 0 Ct C Qt kA Y 1 n ( <br /> CONTRACTOR ADDRESS: STREET 1 Lot 0\ �6( I Tr S T �j� <br /> CITY 1` r `___ta)L.\` STATE ' ZIP—\g(D p� 3 <br /> CO TRACTOR PHONE: &(pp- k+p;- t�r� CONTRACTOR EMAIL: -� <br /> \��' �CS1�YY1�PlYi lel C, ` <br /> GO TRACTOR LICENSE#(REQUIRED):\ tCC- <br /> P ,11 S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):0 S3R-3t7,, <br /> iRIMARY CONTACT: 0 OWNER KCONTRACTOR ❑OTHER(Please Specify) <br /> 4ONTACT NAME: CONTACT PHONE: •'?DUtb - L4 D'%- 1 0 0 u <br /> \J\SCC°, `6t ECONTACT <br /> .x n , .,-W _...... __,.., * N * ttM Cts <br /> Existing Use of Building: Contract Price of Work:$ g%5 p <br /> • <br /> Firo dosed Use of Building: Heat Source: ❑Gas DElectric ❑Other ; <br /> Buil Zing Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial 1 <br /> Type of Project:. New ❑Addition ❑Remodel ❑Repair CIT.'. ❑Sign Sprinkler ❑Demolition ❑Change of Use <br /> S <br /> DE CRIPTION OF`WORK: <br /> kc\f,e w\(\vosa{ \\rstok\\amr\ --o_. t 0— 02- ?. I <br /> ASS CIATED BUILDING PERMIT#(if applicable): <br /> _,.,. _:d C .a n * 1 t O �P 07ertr�...1 1. a4 a r. '^PL+ L� ,,''-.P f <br /> T cpe of Project: New Addn Alteration _Repair Type of Project: _New Addn Alteration Repair <br /> #'of List of Fixtures Fiurfes #of <br /> �'xivres List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg <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 Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: I j <br /> K s <br /> Chemical or Water q No.of Heads ! <br /> AA OWLEDGEMENT I ha =reviewed this application and confirm the information contained herein is true and conact.Work donepursuant to this f <br /> cu n federal,state,and lora The rantin of a permit must comply :she <br /> h I <br /> rr((ee $ 9 permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the' <br /> 8utldi Official before being a o =d under any circumstance.t am fhe owner,or/am authorized by the owner of this property to perform the work for which application is ape, <br /> anti I Imply with the State C.✓ -cto-Law 18.27 RCW and 296.200A WAC. <br /> ( City of Everett Official Use Only <br /> -- PERMIT" <br /> Owner/Authorized Agent Signature Date 0 2( j ) <br /> (Revised 9/23/2016) <br /> 1 . <br />