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PERMIT APPLICATION <br /> 'IP_ BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I(E)everedepett5evenetNita.gpv I www.everettwa.gov/permits <br /> 3 , oraliNlik Ink _ - P ?f lIO <br /> PROJECT SITE ADDRESS: '2401 El/efts-7T t1& VPROPERTY TAX#: CV 7 . 3x it = <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) <br /> p ...:....... :....:www��' ...... Ain :.. ... <br /> yli�lU�•wm.'waw.. ..... v .. <br /> OWNER NAME: 5 x'eV7 s J ( ff)1 � ,. TENANT NAME(If Commercial): 1 j mgey5 IJP <br /> OWNER MAILING ADDRESS: STREET iCileri <br /> CITY STATE ZIP <br /> OWNER PHONE: 4 2$^ 2.SA--3 ire* OWNER EMAIL P ` r i 19 . <br /> GONTRACTO t NAME: ' ", 6: Ind, <br /> CONTRACTOiRADDRESS: STREET /740:z4 /5-0, !{ .5-6. 101/4` d <br /> CITY �4"1""" STATE /t ': ZIP:.. geo/Z. <br /> CONTRACTOR PHONE:4/15--4/8s-t-O'// t •#NTRACfOR EMAIL: +elsr, e,A.!I1 149/F , ell, <br /> CONTRACTOR LICENSE*REQUIRED):CORA"%t i 0 Zi OM CITY OF EVERETT BUSINESS LICENSE (REQUIRED): or r. 4 , <br /> PRIMARY CONTACT: ❑OWNER treONT€ CTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> :CONTACT PHONE: <br /> q2$ v601// <br /> KizisTy . CONTACT Elm <br /> Existing Use of Building: Contract Price of Work:5 /4, "Alp 00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type:,, ❑SFR-Detached ❑SFR Attached DDuplex ❑Multi-Family-#of Units: .Commercial DIndustrial <br /> Type of Project: ❑New ❑Addition 0 Remodel girt= ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 'R <br /> ASSOCIATED BUILDING PERMIT#Of applicable) <br /> E I( ITAPPLICATION 14.01 10101(0 . <br /> ype of Project: _New _ Addn _Alteration _Repair Type of Project: New _,Addn _Alteration _-Repair <br /> #of ', #of [ List of Fixtures #of ti of <br /> List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling UnitsHeat Pump ToiletBackflow preventer'(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping f Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri•eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap ' <br /> Gas Range Ducting Dishwasher Roof <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood _ Water Heater Other: <br /> Exhaust Fan `Sink(Service1Bar/Mop/etc,t Other: <br /> SIR ER 1SUPPRESSION� iY! <br /> Chemical or Water [No.of Heads y <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.1 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 /> Clay of Everett Official Use Only <br /> PERMIT ��V I ! _.i <br /> . Authoriz a,e;,.nt won Date <br />