Laserfiche WebLink
PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98261 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> jy ayps <br /> PROJECT SITE ADDRESS: 000\ 1,00\ 1'cm. -wvozerr,w cis 2at PROPERTY TAX#: V-9O5)700 "6e(WI)O <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . .,...... <. . .. �..,.. . . ... ONTACT INFORMATION;.. ,< . ._ , . . ... ,A <br /> OWNER NAME: I V (-TKO TENANT NAME(If Commercial):kOWNER MAILING ADDRESS: sTREEr J'601 Loi1-(Rf <br /> SCITY , j' STATE wAC"' ZIP 913.PX <br /> OWNER P NE: 62.00 LAN - c2313 OWNER EMAIL: LQ n r t clOCA.eJ h otm of i (• CO -(I <br /> CONTRACTOR NAME: �� rtrt uLS� T(V l j (N,C <br /> CONTRACTOR ADDRESS: smEET t b - ( \ )U' 11C -S <br /> CITY 2l k 29 L\. kkik) STATE bgAJ S 5P( �o <br /> CONTRACTOR PHONE: L - $5G1 $. 33 CONTRACTOR EMAIL. hp - W T, - . � <br /> CONTRACTOR LICENSE#(REQUIRED ( 3 CITY OF EVERETT BUSINESS LICENSE#(RE 'LTC r r <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE: (gO GQ) 1111 W -2 13 <br /> N1X16'1K.t) CONTACT EMAIL: J-ar'7y'rydu IC ltt71"lYlat(- COM <br /> .,BUI DING,PERM00,APPUC/I,'f 1 <br /> Existing Use of Building: O%?Z- Contract Price of ork:$ 4:2J <br /> Proposed Use of Building: LIQ) L ("NQ e..//6414.E(E?) Heat Source: ❑G ectri r <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: _ ommercial [Industrial <br /> Type of Project: ❑New ❑Addition ►-Remodel ❑Repair 01.1. ❑Sign ❑Sprinkler ❑Demolition ['Change of Use <br /> DESCRIPTION OF WORK: /a .-Z;:ip. . / _ <br /> /al* ,�.' Gem. ��� L� , �Q © S R 9 (J -S <br /> ASSOCIATED BUILDING PERMIT#(if applicable): - <br /> ME=:� AN1 L1. PERMIT PPL C/IITTOIIi ` LU Bt RMIT#fiPPLIC ®. <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New Addn ration _Repair <br /> #of List of Fixtures #of List xtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures F" res <br /> NC-Air Handling Units .Yt Pump Toilet ikflow Prev- ter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub al <br /> Gas Piping Boiler k Lavatory(Wash :. in) , • ountain <br /> Water Heater Re ,=lion Shower , Moor Drain <br /> Gas Fireplace W•./ :tove Kitchen ' &Disposal Grease Trap <br /> Gas Range . 'I ng Dish . her �� Roof Drains <br /> Clothes Drye 'ookup , ' Other: C:+ es Washer Medical Gas <br /> Range H.• ater Heater Other: <br /> Exha Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 'Chemical or Water ' INo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is hue 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.lam the owner,or tam 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,e r 1 � - PS. <br /> l� \ Co --0o5 <br /> 0>nikr1Authorized Agent Signature Date (Revised 9/23/2016) ' <br />