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I <br /> PERMIT APPLICATI ?:•. <br /> BUILDING/MECHANICAL/ PLUMBING I SIGN/SPRINKLER/ DEMOLITION <br /> /41,064,,41144 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.everettwagov/pennits <br /> t load±trim g y PI.a IPE*Js*T 004 'KoS ,.:o s <br /> PROJECT SITE ADDRESS: ? 0 F .ci" PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision: Lot No; (attach copy of long legal description) <br /> e <br /> OWNER NAME: r \ TENANT NAME(If Commercial): arra( !f" I <br /> OWNER MNUNG ADDRESS:: STREET c f-7 C `)C, q4ploo 1 i '3tc` , __„,--)c.2./ <br /> CITY I STATE in <br /> t <br /> OWNER PHONE: i OWNER EMAIL _re yz.pe Kyle,r 6,37o <br /> CONTRACTOR NAME: 1t t +)'etm —ea-1-11-)g: 4.. ,.K <br /> CONTRACTOR ADDRESS: ,s'msE I1-7 / g `7(" '? / L J <br /> opt f Vi l STATEZIP c <br /> CONTRACTOR_PHONE:. -?2'-J a --qOACONTRACTOR EMAIL.; - }Y7.. `' rryYi+- r4i // <br /> CONTRACTOR UCENSE#(REQUIREp); y)erveis,64 4 7 ~i1 CITY OF EVERETT BUSINESS LICENSE#(Rls ltilRlwD}t g ;1 , <br /> PRIMARY CONTACT: E7 OWNER VONTRACTOR ©OTHER(Please Specify) <br /> CONTACT NAME: -CONTACT PHONE: Lii 5 w i <br /> CONTACT EMAIL.. <br /> ISG fl �TI . . <br /> Existing,Use of Building: Contract Price of Work $ <br /> L-1611..).-.- , <br /> Proposed Use of Building: Heat Source: rtgas ©Electric DOther. <br /> Building Type: IFR-Detached DSFR-Attached ODuplex OMulti-Family-#of Units: peornmercial ©industrial: <br /> Type of Project: ❑New .InAdditioon 13Remodell FiRepair 0T.i. ❑Sign OSpprinkler ❑Demolition LiCha�nge of Use <br /> DESCRIPTION OF WORK; I i! vl t fr.ld 1- I-efface v'`-p 'r)T <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> r <br /> : ICAs P��' I O$ 5 ,. lJ Old Mt 'PJCATIO N . ., <br /> Type of Project: ___,New Adrift _Alteration Repair Type of Project: New Aridn Alteration Repair <br /> #of #of #of #of <br /> List of FixturesList of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AJC—Air Handling Unite Heat Pump Toilet Backflow Prevehter(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin), prinking Fountain <br /> Water Heater Refrigeration Shower door 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 /> ,� ER 1NKI' 1P RESSI SY `TEM <br /> Chemical or Water I, .' No.of Heads <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm:the Information contained herein it true and r orred.Work done pursuant to this permit must comply with <br /> cunent federal,state,and local law.The granting of 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.I am the owner,or I authorized by the owner of this property to perforin the work for which application is made, <br /> and 1 comply with the State'Contractors Law 18.27 RCW end 296.200A WAC: <br /> Oily of Everett Official Ilse Only <br /> Ø? O <br /> I ". //7 PERMIT'#1 ^ I Z-6°10 <br /> (J 0. <br /> Owner/Authorized Agent Signatur Date, (Revised 9123/2016)) <br />