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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> 11.2✓ se. El/V/2er MALL. W41 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> u , 'kc•NTAcT IfIWORMA i:Ota <br /> OWNER NAME: Carl OP opeiggr TENANT NAME(if Commercial):sow c . Ill <br /> OWNER MAILING ADDRESS: STREET 3/O/}� . D14n S7 ED ' /�/� <br /> CrrY ov5 - 7r STATE WA ZIP /0.1.0/ <br /> OWNER PHONE: 4%9...•....Z07'....SSRI......,... ,.O'WNER EMAIL:.....G/ae 4c.a e(Fere tt We-•.. oil..._.......... . . <br /> CONTRACTOR NAME: g ...TO/ <br /> ) J COVs7121, 77Ot <br /> CONTRACTOR ADDRESS: SWEET b ///P,/,$ pgiL/E p <br /> CITY "7TWAW1 j„ } STATE Wf} ZIP <br /> • /tj''/Q� <br /> CONTRACTOR PHONE: 5 . g+ 3$2O CONTRACTOR EMAiL: will I&w 014S?etie,,410w'net <br /> CONTRACTOR LICENSE#(REQUIRED): p fz"j"oc,p3 gm Z„ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Q530 ®J ' <br /> PRIMARY CONTACT: IN OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 44 . ,15,07 89'77 <br /> C�, CONTACT EMAIL: a1,Yk- +r evcv wer.„. 701, <br /> r. , .-_.._ i : .::._ ...._ :. tW11 DFNG;PERMIT=AiPPda: A'royi -. _. .. _,....',..._ 4 �r. _a —.._..' <br /> t <br /> Existing Use of Building:.2QcE .P /Mr/7/1 Contract Price of Work:$ <br /> Proposed Use of Building: 4e Heat Source: 'gGas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex OMulti-Family-#of Units: Wommercial El Industrial <br /> Type of Project: ❑New 1:Addition Remodel ❑Repair ❑T.1. DSign i:Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - <br /> ��y� ) �� _ �N�'S'),L ���I�JA''�P��.�Py��'�.•�t��t-�?�Wal <br /> �.dyF_..?t'F.,�.[/.4(�ljj� �J'�i-GlSh!.�/�i��E <br /> _..Ti.L �1VD Plr4S../ ._ .f71E-_.���c.v71 J�l�'.�f.einc.(...,_. WC d i.� _.Atcul2E. /'�"1L.So!✓_P404___ <br /> NEW _1/046. igb W -, _1,0 _.4c.cosTICAL_ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> tX ' g4RVypVINIWt9tis■ ittaife ZYPy.VEffi■ ADialtip )NT <br /> s iZ <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: __.New Addn Alteration Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> • A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 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 /> 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 <br /> Building Official before being authorized under any circumstance.f am the owner,or lam 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 /> City of Everett Official Use Only <br /> PERMIT <br /> 01/_,P3 Wq oi <br /> Owner/Authorized Signature ate (Revised 10/12/2015) <br /> CA) 1 <br /> ( <br />