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PERMIT APPLICATION IIIIIPP
<br /> .,..j....,, ,14 BUILDING/'MECHANICAL/ PLUMBING/SIGN I SPRINKLER t'DEMOLITION
<br /> . f CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425457,•8810 i FAIL 428-287-8857 i(E)everetteps©Qeverettwa.gov I www.everettwa.govipermits
<br /> 0
<br /> (i31 i1 - rt'i�Wack tn, a` ��C44e) 4 t sit '• N .. Sit ■ a iii- c d 1,y `* a�
<br /> PROJECT SITE ADDRESS:,. . 5}*,a 1 . .sAyt4ea$A tt$2* er. ::lilt - ,- ., AX#: t ''-
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach co. ng legal description)
<br /> OWNER NAME: fi o+e a.' TENANT NAME(If Commercial): C4,0ic s A Ari
<br /> OWNER MAILING ADDRESS: sTatET "14003 V. Ca.5'',,,o R,a y p
<br /> CITY C�ve,r kl i._. ... • .., ,. STATE' to,,../Tc ZIP 410'2
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 1Jdl+tiltrct 4` ✓ttc1,. ..h,:c.a.l CDtvArLG'f o v r ‘AC.
<br /> CONTRACTOR ADDRESS: STREET I t to 1 I 441 it, '1o.c.t t.Jt.s
<br /> CITY I A4u.,k 4 i Ar-C c STATE WIN ZIP c"S Z 7 5�
<br /> .CONTRACTOR PHONE: 2.5' -^t,1 -41 03 9 e GONTRAGTOR EMAIL: br ,i.lrr L.a t1 e U ' . c.
<br /> `cONTRACTOR LICENSE*(REQUIRED): ,,,,a,'
<br /> J t 1 I'�R t a:' �. ,C11Y �r=EVER TT BUSINESS LICENSE#(REQUI'EEL}. oCO r
<br /> PRIMARY CONTACT:
<br /> WNER ) •
<br /> ONTRACTOR THER(Please Specify
<br /> r.
<br /> CONTACT NAME: CONTACT PHONE: 2 s .- (.1 0 « 'b3 S.
<br /> 'Qt',A.., t i-'C ,L tk CONTACT EMAIL k.a1+c t1 9i ot'"t .i.Co
<br /> _:a � t rI �.,/ "'.,-c '_ i 1- etWittiitII 6 x4ai:4 °y:i' a�iJE.eigt1 .v1
<br /> Existing Use of Building: • Contract Price of Work:$ V ---___--
<br /> Proabs#fd Use of Buiidin*: Heat Soul'te: es r lectric rather
<br /> Btuild(rtgType: OSFR,Getaehed ,' FF Attached tipiex lal ultl-Family-#of Units: =mmercial dustrial
<br /> Type of Project: lewv Eitddition erriodei akepair a:J..1. mi9n rritfkler [emolition,_. [h. . g
<br /> DESCRIPPTION OF WORK:
<br /> 4t,�plate•� Co•rrt(tot ___ —w _ *-.r r. ._ * .�1 *.r•. , t6\c� . 4 „,'31
<br /> ASSOCIATED,BUILDING PERMIT#(if applicable):
<br /> Type of Project New Addn _Alteration ; Repair Type of Project.' ,New _Acirin ®",'Iteration _Nepali.
<br /> *of *of *of '' #F of
<br /> List of Fixtures List of Figures List of fixtures list of Fixtures
<br /> Fixtures Fixtures :FfxVes _, _ ,Fixtures
<br /> NC—Air Handling Units Heat Purr p ': Toilet „_ 1 ackflow Presenter(Ir)side Bldg
<br /> Forced Air Bterns '' Unit Rea# ,_ Bathtt Urinal
<br /> Gas,Piping W Boiler - Lavattl; i,Wash Bssin) Crinking Foudtairr
<br /> Water Heater . :', Refrigetatit ii . " Shower Floor Drain
<br /> -Gas FireplaceWood v q Kitrhet roll&Disposal Grease Trap
<br /> 4'- '`«,1- Dis"iw f ..._
<br /> Gas'Range '� �i�uetfng` _ Roof preens
<br /> Clothes Dryer Hookups 'Other: Clothes Washer Medical Gas
<br /> ... _a
<br /> Range Hood
<br /> Water Neater tither:
<br /> E.xhaust Fyan.. ', .' '. sink(SeT�r ..r/iopietc,) Other: v�,,,_
<br /> m [�
<br /> • Chemical or Water • No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct Worn dote pursuant to this permit mostcomply with.
<br /> Orient*feral,state,and local law.The granting of a permit only aUthortzes approved work,and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building 00101b1 before being authorized under any eircumstanee.I am the owner,or tam authorized by the owner of this proper y to perform the work for which application is made,
<br /> and I comply with the State<Contraators Law 18.27 RCW"and 296.200A WAC. ;>
<br /> City of Everett gfffetat Use Only
<br /> PE,
<br /> v'e 12;31101 it wc$os_ 02...E
<br /> Owner/Authorize Anent signature [date. (Revised 9;23.x2016)
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