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PERMIT APPLICATION
<br /> /1.' BUILDING I MECHANICAL/ PLUMBING I SIGN I SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> '44g1- 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> ,t M Y (v Piie41#TR.S TE7NFO 1UTATION, ..,,,,,. ...., .
<br /> PROJE $ITE AD RS:1, _ i7 r,( ])way PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision N r'"T Lot No. (attach copy of long legal description)
<br /> b 8" - � �... �, i k. _ ya �x� '> .zt
<br /> :--"'"';'--,-4f:g :',71406- tWe.NMERNONSMNAStttikilittriVAMT:��. _ _ �} CONTACT:<I I!I FO��ATIQN': � �..�`��,�,.k.�,:z.h a.�,._:; .,�,._,4 �J_.a�.,.: -�:{r;«q:,._-,.-=NER NAR Il4 ,` ►" '.f� , , TEiVANT NAME(If Commercial): (� jai jS�l�d✓ (mak Stl�r
<br /> OWNER MAILING ADDRESS: - STREET ft) D-o?c, l
<br /> CRY A44.4, iolf A44.4, STATE W/V- ZIP / 8o / 3
<br /> OWNER PHONE: z J 7 3 3 y OWNER EMAIL:
<br /> CONTRACTOR NAME: Xey f tN It /'
<br /> CONTRACTOR ADDRESS: STREET/7 . O (e Ave 5,
<br /> 2.1P.6'.--
<br /> � / CITY [�j7,060,�4 STATE to o z.P 1 S 0{3 2_
<br /> CONTRACTOR PHONE: G/!p'lO 7O`-6 Me 143 (� CONTRACTOR EMAiL: 1j 4 j Nk. -k y JY►ee'1jwV,ke) )4ejm
<br /> CONTRACTOR LICENSE#(REQUIRED): /<'e Y W W 4 Z t O f - CITY OF EVERETT BUSINESS LICENSE I#(REQUIRED): Da't-
<br /> 1
<br /> PRIMARY CONTACT: D OWNER 12tONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ( CONTACT PHONE: *Z.� — 78-54/76,
<br /> .73Ayor,i 1-i ) 0".0OS CONTACT EMAIL: .4 A i,,,,,,,e S tar 4,,,„,..4,„,,,\„..1,6f,,,..(
<br /> W _ _,SIV _... Ns ._..s:.:_S"" :;'.�:; BUI>.:D1.N6'PE.RMf. `APPIICATION"W { . ... `~.:. ._v, .:_ _. .
<br /> Existing Use of Building: r te ) Contract Price of Work:$ // 9 79 GYO
<br /> itJProposed Use of Building: �-a 1(( Heat Source: ❑Gas DElectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached P26-pair
<br /> ❑Multi-Family-#of Units: I ommercial ❑industrial
<br /> l
<br /> Type of Project ONew ©Addition DRemodel pair DT.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTIO OF WORK: N I iIlLReavipL, /(-) C:v �� 2
<br /> fier
<br /> a G� � i( e a�-�w ps, �i*3 Ke®Ftlof a�� -/- Reows p,,,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1,4
<br /> z r MECFj CAL PERMIT,*PP'1CATION {nPLL ismo G PERMITSAPPLiCiATION ,_ntos.
<br /> Type of Project: __New_ Addn Alteration _Repair Type of Project: New _Addn Alteration Repair
<br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures i
<br /> f A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> / Gas Piping Boiler s Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace - Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> ,__i SPRINKLER/SUL!P.14E$SIONtoYSTEM_ M 1
<br /> Number of Heads (
<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 1
<br /> Building Official before being authorized under any circumstance.I am the owner,or 1 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 /> /I,
<br /> CityofofEverett Official Use Only
<br /> (}6,6 , 7-17
<br /> PERMIT# I ! �� 94
<br /> Owner/A horized Agent Sign tire Date (Revised IC!2/2015)
<br /> IN
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