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<br /> PERMIT APPLICATION
<br /> BUILDING i MECHANICAL I PLUMBING/.SIGN i PRI KLER'I DEMOLITION
<br /> CITY.OF EUERErT PERMIT SERVICES;
<br /> 3200'C DAR STREET,EIRE i t WA982(31,
<br /> (F)425- 04810 I FAX"- -257-8857'II.(E)everetteps@euerettwagovt:vw +r.evereth ra.gow,pe►iniits
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<br /> PROJECT SITE•ADDRESS: J =t ` ; 'a V d, _f" y{ RROPEI 1 Y wt,
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<br /> LEGAL.or new c•onstruction:.Short Pjatlsubdivision Lot No W (attach c©pyof tong legal description)`
<br /> � ti ' _•° ., �,,.t;y��s.. �.. e �fis�a��,�Fz�.:.s' se ut ����� "ys .r°9�" F
<br /> -1' �.p ,.n,.* 4",",��.1... _cO$11T40�"IN'N•-e O,s.� -. 1t,: '� -. .J..¢v ; a s�,.,,,1, - , --, ..n, .
<br /> Oiil(NER NAME:' � �` ?ENANIT"N ME"(If Com/ rcial):
<br /> OWNER
<br /> MAILING ADDRESS: STREET U 0 F f:��.l /-fi-' '' q _
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<br /> $TATE. ( (CRY , p
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<br /> OWNER RHONE fi rt`ZEMAIL-.---11q, t�W\& t 1,1 G '
<br /> OWNER
<br /> p'O$TRACTOR NAME: A/'� S ((1.t?C Y11_')tJ i�i-
<br /> CONTRACTOR ADDRESS: sTR 7 I 1 }0 L C{fi...r O lel
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<br /> CONTRACTOR' ONEeC03 L : i1Sttc ! ► t
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<br /> #NEAcfoR` #RE41IR£D) CI7FOF"=1ERET EL/SINEW LICENSE f(RElURED)LICENSE N
<br /> D0PRIMARY CONTACT: OWNER CONTRACTOR OTHER( ease cf ) ' •
<br /> •CONTACT NAME: CONTACT PHONE:
<br /> 1J I., CONTACT EMAIL,, '?'l t'.!I2i 1 woo, U
<br /> F, t' , , � j;NG FER1t IT APPLEC T... .-,_.,...., r.. ,
<br /> Existing Use of Buiilding; Contract Price.of Work:.$ J 00 •c'
<br /> Prosed.Use of Building: Heat•Source: 11GaS DElectric CDOther
<br /> Building Type.: ©SFR-Detached DSFR�-Attached DDup1 CtMuiti-Family-#of Units; -Commercial Q.industrial
<br /> 'Cype•ofOroject,Mew OMdition ORemot el ISIRepair COT.I. gsign psprinkler ODeemolition O`Change of Use
<br /> DESCRIPTION OF WORK.
<br /> --D ' oL--- f d, vatilcie -,ino_it-\ vtconi,v&-- riiti()
<br /> .. o OOtC OY� 9a5 9 i
<br /> ASSOCIATED BUILDING PERMIT*(if ppIicable) ,
<br /> Type.of Project: New_ Addn Alteration• Repair Type of Project: New Itddn .;,....1.teration _Repair
<br /> Of -List or Pixttrr•.es >lisr of r•-ixttires : # +f hist of fvxturs�s of List of Fixtures
<br /> Fixtures Fixtur < Fixtures rt
<br /> -"Air Handling,Units ' Heat;Pump` Toilet ' ,Backflow Preventer(Inside Bldg)
<br /> ForaedAit Systems •Unit Heater ,Bathtub :Urinal
<br /> i Boiler. . Lavatory t(Wash Basin) .Drinking Fountain
<br /> Water Neater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood StoVe Kitchen Sink.&Disposal "Grease Trap
<br /> Goa Ftange. »g Dishwasherottias•Drjrer Hookups Other , .Roof Drains , ,
<br /> CjClothes Washer Medtcal"•Gas
<br /> Rarifj'H:eed Water Heater Other:
<br /> ,; aixst;F'alt` Sink(ServiceFBar/Mopietc.) Othe ;
<br /> l , LEi I4b70 EtSiC1 Y l �::
<br /> •Cli nical or Water '1 �No:of Heads
<br /> ACKNOWLEDGEMENT.1 have reeieweditttisapplication and confirm the:ififormation"contained herein is tine and correct.Work done persuatit to this permit must complywith
<br /> current federal,state,arid local law.:The ranting of a permit only aufhonzes approved work and no.devietions therefrom,Deviations must first be authorized in wnting from the
<br /> Buildiljg•Official before"being authonze4 underany circumstance.I attr the owner,ori am:authoiized by the owner of this property to perf cm the work for which apphcatlon is made,,
<br /> tied l campy with the State Contractors"Law is 27 RCW and 296. 60A WAC;
<br /> City of Everett Oftfcie Use Oh'
<br /> PERMIT
<br /> .,,,,,,T4i,,„_,,..--/A1/4...,
<br /> OwnerkAuthonzed Agent Signature Date (Revised 9123/201 );
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