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PERMIT APPLICATION <br /> BULDiNG/MECHANICAL I PLUMBING!SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET*EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)everetteoS(teVerettWagt v I www everettwa.govlpermits <br /> (Bt a i F i 'Oiy 4>*Ie ..;' ) , pit,. <br /> __ w <br /> PROJECT SITE ADDRESS: 5 ,'[ <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Ptat'stt>sdivisio:y,- <br /> Lot No.' (attach copy of long legal description) <br /> OWNER NAME � or <br /> Ai . � .� <br /> _., ''" TENANT NAME if GommercialJ: <br /> OWNER MAILING ADDRESS: STREET 2806 Lay- ( P r <br /> cI1Y •. P: ...1 <br /> :: ... _- STATE ZIP 54;/C) <br /> OWNER PHONE: I1.' J }WNER EMAIL: <br /> CONTRACTOR NAME: <br /> 11C. <br /> CONTRACTOR ADDRESS: STREET <br /> 14, act_ctkes <br /> CITY elw., °.' IT�y� <br /> sraTE '' ZIP ""�€tr+G�. <br /> CON CTOR PHONE: , <br /> R <br /> "CONTRACTOR EMAIL A =.x,* 41. , * ,,IA A_ at V rill .Co <br /> -,.C{=j}+t_T-RAG/BR-LfCEfstsE-#(Rtltfd#�Ja' ' <br /> ,..w-,. °L " `� t "I` BUStNESB Lt <br /> PRIMARY CONTACT: 0 OWNER ktOONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 2.5 259 *05 � <br /> 1�.j(.1, <br /> CONTACT EMAIL: <br /> rn D1 GIS jot:r, tit <br /> °,,i; f ,, ` °,,, <br /> Existipst Use of Building:' <br /> Contract Price of Work:$ f_tio 0 , 41, OP <br /> Proposed Use of Building: <br /> Heat Source. a . <br /> DElectric ❑Other8ftltl Tl : SPR«tatached 1 PR Attacf#ed DDuplex ❑Mu.ti-Fatrlly of Units; OCommercia <br /> t ❑Industrial <br /> -- — <br /> T. of Project: ONew DAddition ORemodel RRe*air CIT.!. DSI=n. OSwrinkter ODemolition ODhe le of Use <br /> DESCRIPTION OF WORK: <br /> 'i - u.s rrc-ciz._ run 1 i nReef -)b <br /> ) <br /> I i &cis Irk <br /> ASSOCIATED BUILDING PERMIT#(If•applicable);„ <br /> Type of Project: _New _ Addn Alteration ,Re_air t'lA <br /> #'a1 cif" a <br /> Repair Type of Project: New Addn Alteration _Repair <br /> Qt FLxturRS, .- l .6.Blk71ut ae... <br /> i,r-tktt>f � <br /> #of <br /> "tits :.;',f- .'>., #of <br /> Fixtures fsf L <br /> NC—Air Handling Units_ Heat rump Toilet <br /> Force Air S tems Unit Heater Backfis� r Preventer Inside Bid* <br /> � � mPe�tar - <br /> �- :Gas Piping . BathtubMIIIIIIIEMEIIIIIIamnmNim <br /> aoiieran "s. Wash Basin <br /> Drill'MIN kin* FountainWater Heater Refd raticr. Shower JeItali1Gas Fireplace Wood <br /> Stove Kitchen Sink t31s•psal. <br /> wGes Range Ducting Dishwasher Roof-)t <br /> airsClothe D er Honku:e the.. Clothes Washer MediwGa <br /> sRan a Hood Alater He ter ttheclta tFan <br /> Sink{servteefi artMepletc: Other <br /> ;S P 1[w KLErt i. tIPPRESSION-SYSuTE ' fi g <br /> o, <br /> aChemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein is True and correct. Work done pursuant <br /> I1rstbe to this <br /> hpermit orized imustwriting comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must <br /> Building Official before being authorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the workautfor whichn applicationfrom isthe made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> n City of Everett Official Use Only <br /> PERMS(' 1 10 <br /> 1-4 M <br /> Ow,:r/Autttoriled.Ag= Striatum atu ` p l/2M'JL�jry/ <br /> Date k- .T <br /> vised' L'1 .. I6) . <br />