|
PERMIT APPLICATION
<br /> BUILDING I MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION
<br /> ":„..41t4Heiv:/'—g44.3, CITY OF EVERETT PERMIT SERVICES
<br /> '` 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@ evereettwa.gov l www.everettwa.gov1permits
<br /> Y
<br /> PROJECT SITE ADDRESS: 0 l ietSkeelti 4c:)t e. PROPERTY TAX#:
<br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description)
<br /> OWNER NAME:1W;VI p moi,,,,. k;i^�r &t,ys)0,6 TENANT NAME(if Commercial),
<br /> OWNER MAILING ADDRESS: STREET 't.e,p"1 4 ,e ejk e r.,,,,,k, ( yy
<br /> vrrr l)V.(• STATE a., 2IP:`w( k
<br /> OWNER PHONE r .. 5-0‘,„? so, 1 OWNER EMAIL :'ry"v'-K` ht4!may"e ht 4 re"r
<br /> CONTRACTOR NAME l N„..-r),s-'t-„r-a— ,e,„....4.i.,,„ 6.va,ss, lio,;..
<br /> CONTRACTOR ADDRESS: STREET Ick '' S-k . 'st# .
<br /> CITY ll
<br /> Y t rL._`l`-` s, A 1, °' STATEt.,01-�'. . . . zAstz--6
<br /> CONTRACTOR PHONE: 1.,Vat, ”? `,j--`.:c.k -
<br /> 04_ t CONTRACTOR EMAIL::n.. . ',-r..e Ac e'r ;`�; r�wOritect n .460,
<br /> CONTRACTOR LICENSE#(REouiREQ) mw—,,, 14 CITY OF EVERETr BUSINESS LICENSE=#(REQUIRED)c 1/4„k 41
<br /> PRIMARY CONTACT: El OWNER itICONTRACTOR 0 OTHER(Please Specify).
<br /> CONTACT NAME; ( CONTACT PHONE: '[ ,, j -` G -
<br /> of- -L � c
<br /> ti L kc v-4 k CONTACT EMAIL:cr^ci 4AtTY` ^tt� r 1(Neu 'V i e
<br /> }�.F . z v.,. 1.- .V,:!‘:.
<br /> _... .,.,, ..rte ,.., y✓:— _N _k.-.._ ...,>.x. �.����� �, ,�Y w., 2.a i,. .. .. ., -.i„ � �.�.... �n:
<br /> Existing Use of Building: Contract Price of Work: X(.4 T16.
<br /> Proposed Use of Building: Heat Source: CIGas DElectric ClOthet
<br /> Buildin pe: -Detached- R-Attached DDuplex ❑Multi-Family-#of Units: C1Commercial Cl Industrial
<br /> Type of Project: New 1:1Addition DRemodel 0Repair CIT.I. CDSign: CISprinkler DDemolition lJchange of Use
<br /> DESCRIPTION OF WORK: n
<br /> t Vire°. K% :,.►' -.. +'kti. AA..cse rt.e tat..E'er.tom v-` ,e0-YW
<br /> ASSOCIATED BUILDING PERMIT#Of applicable):
<br /> Type of Project: ,•`New_ Addn., Alteration _,,,_Repair Type of Project _New Addn _Alteration. _Repair
<br /> #of #of r #of #of
<br /> List of Fixtures List of Fixtures " List of Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC-Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> i 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 Hooltipps Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/BariMopfetc.) Other:
<br /> ]Chemical or Water ' No,of Heads
<br /> ACKNOWLEDGEMENT I have reviewad chis application end confirm the informatlo,F 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.I am the owner,ori am authorized by.the owner of this properly to perform the work for which application is made,.
<br /> and I comply with the State Contractors Law 98.27 ROW and 298.200A WAC.
<br /> City of Everett Official Use Only
<br /> ?)''c541/N1/4' 1111) . 1 6' .4 gl
<br /> 6 PERIM'#
<br /> (y nC�
<br /> Owner/Authorized Agent Signature Date (Revised 9123/200
<br />
|