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PERMIT APPLICATION
<br /> /11P/0106**7--/-:‘
<br /> BUILDING / MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> .4117-4
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: 144'50 WI Cet # (2_. PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: Toy1 T77L-kl tU.&_12- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET Edi1 t
<br /> CITY l tea— STATE V V f�, ZIP 1 5/2_6 'i'
<br /> OWNER PHONE: 1 • I.-{c • sc., ( OWNER EMAIL:
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<br /> {� Ae. _� -1-byre, St:1
<br /> CONTRACTOR NAME: I Ot���.Q,$�IJY1'f�lY�SjC�Q11"��'f (�Y\.S
<br /> CONTRACTOR ADDRESS: VSTREET CO f les �/JC, 11,R
<br /> CITY �a, �V L,L U STATE Ma_ ZIP `12.9-0
<br /> CONTRACTOR PHONE: 3(e0•to6g •96 CONTRACTOR EMAIL: j 1 e- Ccuk-
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<br /> CONTRACTOR LICENSE#(REQUIRED): 1 a24s CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): L�O
<br /> PRIMARY CONTACT: 0 OWNER NICONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CON, TACT PHONE:
<br /> HONE: ) ,tpc. . �d( 0
<br /> L ✓& &. CONTACT EMAIL: 1,( ',PG � �
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<br /> Existing Use of Building: Contract Price of Work:$ ?1000
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> Building Type: ❑SFR-Detached iSitFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel igiRepair ❑T.I. CI Sign ,,❑,Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF ORK:,1 , kk Q A � s
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> AVOV6�b ;:i0 �."- =S �� � y�Fr I sId" r i y-/� ■rr�- � *- �a 4�.r��s�h lrul r
<br /> Ilii: .'�.', ,CAL PERM ., ,. - b . . „.'"a..",.,s.,�. ,r',-,,0,4000ING;PERM t �4.s.'. O ff.4t-.�r,. , YI i.1!,
<br /> Type of Project: _New _ Addn _Alteration _Repair 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 Handlin. Units —Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> I 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 Ranee —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 /> 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 Oficial 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 I ,ly with de State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> J PERMIT#
<br /> ;�� iI �� ,ter M1711• O
<br /> Owner/`' thorized Agent Signature D to (Revised 9/23/2016)
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