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PERMIT APPLICATION I
<br /> BUILDING/MECHANICAL!PLUMBING.!SIGN/SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET EVERETT,WA 98201
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<br /> (P)425-257-8810 1 FAX 425-257,8857 i(E)eyelet epseeverettwa.goy 1 www.everettwaigoWpermits
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<br /> PROJECT SITE ADDRESS: 1 (( S E gu i!An of F Ewe*Mali GO,•PRopetrf To.*
<br /> LEGAL for new constructon: Short Plausubravision Lot Na (attach copy of longJegal d--.'•'Ort) -
<br /> 4', 00,4110-1q100",i0ft7 .1 :,97k.K5r, ,7?', :" ikar-:7-1:"--;t:.,e!:::::::::
<br /> OWNER NAME: TENANT NAME(ff Convert* : _waif i sob rk
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<br /> OWNER MAILING ADDRESS: smser
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<br /> STATE ZIP
<br /> OWNER PHONE;
<br /> OWNER EMAIL:
<br /> CONTRACTOR,NAME: V V1/41,,,S C)YX2..., Pi Lk 111 6,i l'A 6 (....,,L C-
<br /> CONTRACTOR ADDRESS: wrREET LO<2,. . '2,1 +tl
<br /> CIT, b\--VIC 1.,t ,LA.)A-- STATS usA ' .,,, ciftat
<br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL: 01 (Y‘ni‘ti e..... r .4.r /I iiiiiiitactthi
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<br /> CONTRACTOR LICENSE*REQUIRED): PLAIS DtPitps' bw !CITY OF EVERETT BUSINESS LICENSE 'REQ /0): iii-4 Cla 2-
<br /> PRIMARY CONTACT: DOWNER at"ONTRACTOIR I]OTHER(Please Specify) - '...
<br /> CONTACT NAME: CONTACT PHONE: LASS:7)-3,i Iuto- L / . lib
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<br /> CONTACT EMAIL: Oufv-libYN t e/pill,&_.1-1/4 eri,e,Sr f fart
<br /> Existing Use of Building: Contract Price of Work.
<br /> Propo,sed Use of Building: Heat Soraw,---047as 0Electric Offer
<br /> S--------156
<br /> Building Type: °SFR-Detached 0SFR-Attaohed ODuntex 0,, ' otnily#of Units: C2Comne4Cial E3Industrial
<br /> Type of Project: EiNeW DAddition 0Remodel ClRepair iit T.t. [XVI OSprinkler inDemolition Oitange of Use
<br /> DESCRIPTION OP WORK:
<br /> peRmit,„/„...---'''' rill, lini fl 41 tl I
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<br /> ,ASSOCIATED BUILDING #(if applicable):
<br /> '-',:441ifiECtratt~f0,,,,—*ItOltit:40-0.4041''',",,:',:',' '77'32; ;'''•';,4t;.14$11004:0:PERMitA0,.
<br /> Type of Project New Addn Alteration Rep Type of Project: New _Addn AI eration _Repair
<br /> *of #of #of #of l
<br /> Homo Lib i b f Fixtures Fist s Li-, .1 Roams Fut $ List of Fixtures Fi 1 uer of adores
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<br /> A/C-Air Handling Units eat Pump Toilet Badcflow Preventer(Mside Bldg)
<br /> Forced Air Systems Unit Heater ,.. _ Bathtub Urinal
<br /> Gas Piping ,Boiler Lavatory(Wash Basin) ,Drink ng Fountain
<br /> Water Heater Refrigeration Shower ' ° Floor Drain.
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal ' Gm==.Trap
<br /> Gas Range °noting : Dishwasher Roof grains
<br /> Clothes Dryer H.. ups Other: ., 2,„ Clothes Washer Medi.,I Gas
<br /> Range Hood I Water Heater Cafe,
<br /> Exhaust F- ' tic Sink(Servise/BariMoptetc,) Othe
<br /> or Water SqtrirOtGltltV—SVEMV,-,;-=;,-s , 1
<br /> Chemical 'No.of Heads
<br /> AC .,OWLEDGEME h f r I have tevievvviil thts apPlroatiOn and tronfirin bre infonnation contained herein is true and correct Work done pursuant its potmh must comply arith
<br /> real;Were(statet,end,bCal law,Thearantingot&permit oho,authnitses approved work and flo deviations therettriM.Deviations mfest ust be utholized in writing*ravine
<br /> SaiVing Official before hong aufixtrizfzd under any circumstance.I ant lie hamar,or f am aothodzed by the owner OfIlls properly to pertoim the afork for which application is made,
<br /> sell comply with the State Contnetkirs.Law 18.27 Row and 2.96.,200A WAS,
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<br /> City of Eliefett Official Use Only
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<br /> DwnerrAntho•-,..Ag1F,- , re Date (Revised t t.,
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