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II II I' II PERMIT APPLICATIOIII <br /> BUILDING/MECHANICAL/PLUMBING/SIGN 1 SPRINKLER/DEMOLITION� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www evere p !ov/permits <br /> _ "� . s - ,gym y�-z <br /> PROJECT SITE ADDRESS: �' k (*ALA (I f \ PROPERTY TAX#: ,V <br /> LEGAL for new construction: Short Plat/subdivision ("C Lot No. (attach copy of long legal description) �t <br /> OWNER NAME:L (/l./Y & I 0 TENANT NAME(If Commercial): <br /> / <br /> OWNER MAILING ADDRESS: STREET 1 /0 l/ CI,Ld LA i2. <br /> CRY STATE �A-- zip <br /> 9 r,cs <br /> OWNER PHONE:4 dith. '- 1 (, 1' ,r \ OWNER EMAIL: <br /> CONTRACTOR NAME; Q l ,_ '' t� <br /> CONTRACTOR ADDRESS: STREET \ \,�.Q. �j�f &\- - ian) -4- <br /> CITY l 1 � / <br /> v � /STTATE LA,_ A- ZIP , <br /> SAP <br /> CONTRACTOR PHONE: cV 1. 1 I3 CONTRACTOR EMAIL: `( g <br /> CONTRACTOR LICENSE#(REQUIRED): IIIrn' 1 "CITY OFEVERETT BUSINESS LICENSE#(REQUIRED): Z <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CO TACTAME: q - CONTACT PHONE: t–(-1 -—1 1 1 .1 (3 <br /> ci <br /> /µ ��� � (\/ -0.4 2._ CONTACT EMAIL: <br /> Q' r <br /> m <br /> Existing Use of Building:. Contract Price of Work:$ (1N0 <br /> Proposed Use of Bu' ing: Heat Source: )6as ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached �❑Dex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: <br /> CI ❑Addition ❑Remodel 1rJRepair ❑T.I. CI Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> L yC- 1 ii, k " v\8 FLA,Viii► cam.- t_ a ( `-'f'. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IAEC A OWIA. ItAtaTal7 N; : , w 2 `P BI G,PE, l '�•-�KIG ► D ns l <br /> Type of Project: _New Addn Alteration Lliepair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of Ust of Fixtures #of List of Fixtures <br /> Fixtures Fixtures 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 t 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: <br /> 't n K U _' ES.. ON S mT <br /> Number 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 onty 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC., <br /> 1 <br /> City offEverett Official Use Only <br /> Owner/Authoriz=.Agent Signatu Date (Revised�10/12/2015) <br />