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PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING/SIGN 1 SPRINKLER/DEMOLITION <br /> .4` CITY OF EVERETT PERMIT SERVICES <br /> T <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PRIBENSENSESSERESEEntakij .. <br /> PROJECT S1I2/DISE;VVE, 7T M4GL 4 yPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> S .. 3 ®gryp p@pp c-:�-g�+ �q7q q�j.�-aq-�^.,p.:-�+:.�-yam.. � 4 <br /> 4`a E' .-x _ 4 "a- �,C00 ACTIN OS61tllHR;,tl O ..,1 ..t_.. .1: 1.-x..__ ->1.,_ . _E <br /> IR <br /> OWNER NAME: ("/7'YrJ 1/0 TENANT NAME(if Commercial): SNOH• CO. 7/� <br /> OWNER MAILING ADDRESS:''__ __ jjSTREET 3fO/ cep/0g .j"T/2 E 7 J� <br /> CITY V0/ - "STATE W4 ZIP 7TJFf�J � <br /> ) <br /> " / <br /> OWNER PHONE: 4 •,Z57•...5017 .... OWNER EMAIL: G etNek " emit V4.41YR1 t• ov <br /> (/ <br /> • CONTRACTOR NAME: TO/V C.W' 77 lkone/J J <br /> CONTRACTOR ADDRESS: STREET ,..1 qWI 6, /A/P0ST ZT j((f/ <br /> CITY / U/ LA' STATE WA ZIP 9s/T O <br /> +C <br /> CONTRACTOR PHONE: 7 • 2181•- 50g.,0 CONTRACTOR EMAIL: IN11I( buy 7LOj/601497/Gi'l oil. if <br /> CONTRACTOR LICENSE#(REQUIRED): ovg.TOG / ' M Z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):4050001 <br /> PRIMARY CONTACT: X OWNER 0 CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,40,t. . 257. 6617 <br /> CMIs % JJ( CONTACT EMAIL: d„,,,*_„e edGYC 'LUa.. 47 op, 1 I <br /> Existing Use of Building: pj,�j,jaf. pRee,j /'7// Contract Price of Work:$ 7O1 <br /> Proposed Use of Building: $ALS Heat Source: YIGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project ❑New DAddition ❑Remodel DRepair DT.!. DSign DSprinkler DDemolition DChange of Use 1 <br /> DESCRIPTION OF WORK: <br /> A <br /> ?,-- um <br /> �lyww,e— r---4._V}!fs_�_. �4 _'?H 1Z�105T 't _ sU�' LJ -- --_--- E <br /> _GA11.,,1 =s_To ._ X-I$77416_ P7oP__UVCT_ - — <br /> ASTOCIATED BUILDING PERMIT#(if applicable): 1 <br /> . E sMKORKNj(;GI-WW RtViA'i',APP. ICettitO :: .-.,:.. s :.: _LL B PiG PERiV11iT'Att#00 ilii-N ._s '" __ <br /> Type of Project: _New_ Addn ,X_Aiteration Repair Type of Project: New Addn Alteration Repair <br /> ) <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures 1 <br /> Fixtures Fixtures Fixtures Fixtures <br /> EXIS " A/C—Air Handling Units Heat Pump Toilet - Backflow Preventer(inside Bldg) I <br /> Forced Air Systems 4. Unit Heater Bathtub Urinal i <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain i <br /> Water Heater Refrigeration . Shower Floor Drain <br /> , Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains t <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas 1 <br /> Range Hood Water Heater Other: ii <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: 1 <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with I <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.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 ROW and 226.200A WAC. <br /> City of Everett Official Use Only 1 <br /> PERMIT# <br /> /LAW. / €,2010 !( i g6 6 <br /> Owner/Authorized gent Signature Date (Revised 10/12/2015) i <br /> (j f <br /> I <br />