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AIIML <br /> PERMIT APPLICATION <br /> ii,r;.-mostbir,, ,' BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everette euerettuva,gov I www,everettwa.gov/permits <br /> `'.,`kms = g__fix w ,1 ,; - <br /> PROJECT SITE ADDRESS: &$31 C'y i rt SS St Evfe1 q$i- 3 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> aa yy }} yy zS�<{M <br /> OWNER NAME:: ,. ttO,V'I o <br /> " C .; r ._ TENANT NAME sell rtxtrnfctI�, <br /> OWNER MAILING ADDRESS; STREET o . 92.. C' • PBSS S-y'ee 1./ 9 Q <br /> CITY tveMe �...... STATE Vv ZIP O so <br /> OWNER PHONE: Zt7b s' �' 2 . 1 et <br /> 4g-- 0 OWNER EMAIL: ►✓L'. / Gn© -c„om <br /> CONTRACTOR NAME: , i POD1- ' I /rI''.b <br /> CONTRACTOR ADDRESS: STREET <br /> 1C )0sj1 6lJ ,Sthe <br /> _.. CITY J V a.411z.- .. 1.: STATE '`i ._ Cj.1 V 8 <br /> 21P <br /> CONTRACTOR PHONE: 501 ^ 8 4s..,3 107 CONTRACTOR EMAIL: d Ic, G6. me moor wa <br /> CONTRACTOR LICENSE#04Ecimtftoop M I, Rp( t () 22 ti& tTY OF EVERETT BUSINESS LICENSE#(REQUIRED)M <br /> 13 toirb <br /> PRIMARY CONTACT: ID OWNER Q�CONTRACTOR 0 OTHER(Please Specify) <br /> n <br /> CONTACT NAME: •CONTACT PHONE: 26v.. " sO_ so <br /> 066+-1'h0.1., Sr0-14 <br /> CONTACT EMAIL: l'OpjtAtA11s mrroO-t- St ak .vvrYi <br /> rte i4 :; n -1-3::1''''''.:‘ <br /> W- <br /> • <br /> Existingj Use of BuildiContract Price of Work:'; <br /> P.m,..-ed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duptex ❑Multi-Featly,-of Ulilts:* ❑Commercial ❑Industrial <br /> Type of Project: ❑New, ❑Addition ❑Remodel CIf,ep* ❑T.I, OSitt i= ❑Sprinkler 0 Demolition ❑Change of Use <br /> 'DESCRIPTION OF WORK: <br /> SSO+ IATED BUILDING PERMIT#(if ppttcabla): <br /> 0.''� Tf a ''� ;tn - ons ' . :'gc 7rs�.. _�� <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn _AIteration Repair <br /> 8 df List of Fixtures #of List fixtures #Of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units eat Pump ' <br /> 1 Tatlet 1 ackftow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler ILavatory(Wash Basin), Drinking Fountain <br /> r <br /> Water Heater Refrigeration i Shower Floor Drain <br /> Gas Fireplace ood Stove, C Kitchen Sink&Disposal Grease Trap, <br /> Gas Range - Ducting 4 "Dishwasher '' Roof Drains <br /> Clothes �H.-:Drye ooku s` Other 1 Clothes Washer Medical Gas <br /> p <br /> Range <br /> „�, " ;Wafer Heater Other. <br /> Exhau an 'Sink(Service/Bar/Mop/etc:/ Other <br /> Chemical or Water No.of Heads I <br /> ,._ <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 /> fiiritditi s Official before being authorized unde 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 /> a , ,c,'.• with the State Contractors La . $.27 RCW and 296,200A WAC. <br /> , City of Everett Official Use Only <br /> . PER c <br /> n -- co <br /> 0 neriAut orized A#.nt.Sign: ._{ Data ,(Revised , 16) <br />