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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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: {Q.S C (keehv-c 9- E1isrc•t `,t/A "t .01, PROPERTY TAX#: t0j�(o3 39 1509 CSI
<br /> LEGAL for new construction: Short Plat/subdivision 0 N ` - of No. (attach copy of long legal description)
<br /> xN a 'fi I r e t'"" wrr�titin n t ih ttl6 r ° s t TxrG — M t i s = a M1 4 �'
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<br /> OWNER NAME: ,," C., L( TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 111.6(:, 1 J Sill St
<br /> CITTYKetA Wt vYL V V STATE A ZIP CT•g�/a 8
<br /> OWNER PHONE: g,06--11.91" ` (O OWNER EMAIL: r'AK657 PA/' eZcp✓t'tCk-S"I'•YtVf.
<br /> CONTRACTOR NAME: 5eR t/j 0 of /C/, evert: f 4he 54e(Jie,. ;/1414(/'�
<br /> CONTRACTOR ADDRESS: STREET t'Sj0 C d(ll 41/.(_, �4� r0 `A' y
<br /> CITY . /104tatM YS✓\ 1 STATE �JJ ZIP i p�/a w
<br /> CONTRACTOR PHONE: L( 1 —7$(90 CONTRACTOR EMAIL:4a,"'rot I vvprveytvi4t1,4,a.cowl
<br /> CONTRACTOR LICENSE#(REQUIRED) ERVF' S S7 I KO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):(3.5.q a Cl
<br /> PRIMARY CONTACT: 0 OWNER , CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: L.{ .237(9_-7q ,Q
<br /> OW/,1O (0-frOtii CONTACT EMAIL: Sc4iolikco rUere)e -ve.fWcc1cc0,1
<br /> {'� i�1it"sl` i ^=." «N tii�i .l w t�"'"; ' t�??;�aH a ® 7,7 t,7: MIh *U'fil�.Y ® M G ��� a^ gym.^
<br /> --�,3. �1� a.,.6asaae,�,d���``,- -,-...�"^'t. �` "`€.� ®� - -.�?.'� ��,�i� -�. � _> —A—�s.�. a���,�. -.n �'-.�� .. w<i� >
<br /> Existing Use of Building: le. Contract Price of Work:$ KO/00 0 e °`9
<br /> Proposed Use of Building: (.,t,vIne et c,,j(,+sk, Heat Source: ❑Gas „Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ,Jbuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: :New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Changgee-ofUse
<br /> DESCRIPTION OF WORK: p1 4-,),t- du wt eb( AQ wt 43 rLt/,vtdewas,Ic,u /dv`/u.-t(I t f k5,1 v/ et.4 CPiJ W( 1, ,
<br /> 516L't1 r po.ttif1 h•nc f 5 f (ot,n4 J5, 1 T7 f (a i1 i V*/ C44445 ( 2` • ' i1v .4)'cC° An l' o4'
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<br /> ASO IATED BUILDING PERMIT#(if applicable):
<br /> 1111*0:,AN CA;15001:17' APP` IC*T I *!; ti ttt.V:W*0#PERMIT APP A71± N � .
<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 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:
<br /> 1 _ ,..S Rlr6I 1 _ OOPOS C N-SYrSO*
<br /> Chemical or Water I 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMi-TC____
<br /> ' /=7-- ''' __,/, /Lic2 - ect3
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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