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PERMIT APPLICATION
<br /> "IP•11/40 -----A.
<br /> BUILDINCECHANICAL/ PLUMBING /SIGN RINKLER/ 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 /> ,:�1111 : .Aftii ° s C . ®, ..,tis...., . ,� ' ® `c'�� lq:;:v . , x1 44, it '€,�+,r `:4z .
<br /> PROJECT SITE ADDRESS: D lot 14• R l,Dil-P AA•r* PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME: 'IN FtSI-f 1461/111 STA-M ,tAN tLkl12 11 f'TENANT NAME(If Commercial): .o C r Lam' (OLA %G6(.
<br /> OWNER MAILING ADDRES- STREET, i U a leflicZ /, tt
<br /> c� 9P"S 1 14 24514I SA-N.4'410!J G.t �
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<br /> ' 'Ty yter 1 i i t/Qt v L'1`/ `W
<br /> —. STATE ZIP CI U(08 b
<br /> OWNER PHONE: 3676 * g 1 r' ci7/3/i OWNER EMAIL 1' 5,1fi511611ire-1 Logo I/1
<br /> CONTRACTOR.NAME: 1-115P"to`I A\\ t'.aNsrri Gri cih.)
<br /> CONTRACTOR ADDRESS: STREET U e71 ,W/ 1, AinzesPr , 61/t1" '1Jp0I7O
<br /> CITY
<br /> n crF\� 1f ; STATE V a ZIP (0 1 0
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<br /> CONTRACTOR PHONE: 0 ` Gt • (46;‘f i CONTRACTOR EMAIL: -IN"el OO4e 1419YM `) fte-P•Lii'
<br /> CONTRACTOR LICENSE#(REQUIRED): \ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR\ MOTHER(Please Specify) 1t ,.. f1t•' � ��
<br /> CONTACT NAME: \ CONTACT PHONE: ,26y9• oet g • I ipot"?j
<br /> 6411\A AlOnker 1A` ,k, CONTACT EMAIL: (2• t- C ‘ { -17P'tI' ' l--C4r4'tf•LONA
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<br /> Existing Use of Building: \ Contract Price of Work:$
<br /> Proposed Use of Building: , eat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached CI SFR-Attached ❑Duplex ❑Mu,i-Family-#of Units: Commercial CI Industrial
<br /> Type of Project: ANew ❑Addition CI Remodel ❑Repair ❑T.I. ■, ign CI Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: S 1121-J \ V�. - Vi v`
<br /> 17 -M itNre r 'I� 4 U)T Per b I C 1c( s1a VV tAspari. ` .
<br /> pm-v-c►4cl fog-- ov -Err 660,4 /u tV i ty 60 'tt, k - lig
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> '. ;jet,._ f,A?,v.A.,.9?.. j-1d.4-I a ®' • t z '.,*rk „, . l t i 4.1 P.. A.,`�.vaZia-u 2 -,
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<br /> Type of Project: _New _ Addn Alteration _Repair Type of Proi\ct: _New _Addn _Alteration _Repair
<br /> #of Fixtures List of Fixtures Figures List of Fixtures Firma of
<br /> List of F,\ures Fleur s List of Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet \ Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems —Unit Heater Bathtub \ Urinal
<br /> Gas Piping —Boiler Lavatory(Wash B.;sin) Drinking Fountain
<br /> Water Heater —Refrigeration Shower Floor Drain
<br /> Gas Fireplace —Wood Stove Kitchen Sink&Disp,•sal Grease Trap
<br /> Gas Range —Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups —Other: Clothes Washer Medibal Gas
<br /> • Range Hood Water Heater \ Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop\-tc.) Other:
<br /> I
<br /> Number of Heads 1
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. I
<br /> ork 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.D iations must first be authorized in writing from the
<br /> Building Official bef. - eing authorized under any circumstance.I am the owner,or I am authorized by the owner of this pro erty to perform the work for which application is made,
<br /> and I comply wi, ate Contractors Law 18.27 RCW and 296.200A WAC.
<br /> j __ ,, (i (,, / City of Everett Official Use Only
<br /> / I PERMIT..# _ SI 7 0 P,(5
<br /> _ '7411 _ -
<br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016)
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