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MI111111III _.__. -__ -- ________ <br /> PERMIT.APPLICATION <br /> a;, ,:-.„_.:-,.,2,---rBUILDING I MECHANICAL I PLUMBING I SIGN/SPRINKLER/DEMOLITION <br /> ¢, ,;r �s CITY OF EVERETT PERMIT SERVICES <br /> ,,, ;�l, I'7 3200 CEDAR STREET,EVEPETT,WA 98201 <br /> (P)425-257--8810 ( FAX 426-257-B557 j(E)everetteps@everettwa.gov I www everetfwa.goviperrifs <br /> (: 4 44.ffai i Junk,C j Pitease) ti.W.Ogrkirte 11 /�t«` 7IJ) 1 <br /> !PROJECT SITE ADDRESS: <br /> !1/f) i 2,(1'I r2g 7 /4Gay PROPERTY TAX <br /> Lot hlo. (attach ropy of long legal description) <br /> LEGAL for new construction: Short PFatisu6divtsion <br /> OWNER NAME: /•..•.ta"E . -- ' , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smear /1/61 / /-- —71,47c,ee <br /> r <br /> S ATE 1-4-44-, ZIP e <br /> OWNER PHONE <br /> ctrl �.'�/�1�1 <br /> I, <br /> rf 15 ST7 ..5(i 'OWNER EMAIL: .. . . .�...,. . �. <br /> CONTRACTOR NAME: ea,'L t 4t _.N wf1 4 ,QL r <br /> CONTRACTOR ADDRESS: STREET 22Z PA-<: L <br /> cilY STATE { ZIP 4 ii2 t <br /> CONTRACTOR PHONE: S' 2•S) 1_$2-_ 51(4- !CONTRACTOR EMAIL: € et-C 01 tt✓ =E"3 tt4 <br /> GONTRAGTOR L(CENSI ikREt uiRED) a1 2 S sf't eir '" • CITY OF EVERETT BUSINESS LICENSE g(REQUIRED):Oa dYX, y <br /> PRIMARY CONTACT: CI OWNER '<CONTRACTOR 0 OTHER(Please Specify), <br /> CONTACT I IIAME: CONTACT PHONE: k�} C., <br /> CONTACT EMAIL: p i�t..rQ a 45 cam., ezi, .:_ <br /> ° ' .>. •BUIL?INt PERtili APPLiTIO1� '. .'. , <br /> '-'• ''''31 • <br /> Existing Use of Building: o Contract Price of Work:$ Vim: W <br /> / <br /> ' Proposed Use of Building: Heat Source: l ass C(Electric 00ther <br /> Building Type: USER-Detached CISFR Attached EDuplex COMultl-Family-#of Units: ,`Commercial Ulndustrial. <br /> Type of Project: ONew ElAddition ElRemodel %Repair CIT.I. �^❑Sign OSprinkler CIDemolifion UChange of Use <br /> • <br /> DESCRIPTION OF WORK: A 1, . , G t ``''t ti_-:0 GvLt t 5 t" 'fir!I <br /> • <br /> ASSOCIATED BUILDING PERMIT* ifap•linable} <br /> _ i 4C NJucAL; _Wgit n'A PL>«AT'fO1. '• . PIi1>1 > »N*6 i k sT` 4 0Atli® i ... . . <br /> Type of Project: New Addn _Alteration Repair 1 Type of Project: New Addn Alteration Repairti <br /> i hof LfstofFixtures 4'of List of Fixtures <br /> of List of.Fixtures of List ofFixtwes Fixtures <br /> Fixtures Fixtures Fixtures <br /> NC—Air Handling UnitsToilet Backflow Preventer(Inside Bldg) <br /> Heat1110111 Pump: Urinal <br /> Forced Air Systems 1 2..—. Unit Heater Bathtub <br /> Gas Piping JIM BoilerLavatory(Wash Basin) Drinking Fountain <br /> OMMI Water Heater ;lIMM Refrigeration + Shower Floor Drain ~1111111.11 —1,' <br /> Gas,Fireplace I�Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range ;MOM Ducting Dishwasher • <br /> Roof Drains <br /> Clothes Dryer Hookuis Other: Clothes Washer Medical Gas <br /> Water Heater Other: <br /> Exhaeust <br /> t d I Other: <br /> Exhaust Fan I Sink(ServicefBar/Mopletc.) <br /> 111111111111111111111111 1111111.1111111_111 <br /> Number of ends _ _ <br /> correct <br /> d <br /> ne pursuant <br /> this permit must comply with <br /> ur oNOedere1 state,an local reviewed this ig application nend wenn the nly authorizes aormation contained herein Is true pproved approved work and no deviations therefrom,Deviations must first be authorized in write from the <br /> :urreng Official <br /> cia_ and locallaw.Tha grdefmg permit <br /> 3u/feting Official before being authorized under any circumstance,1 em the owner,or!am authorized by the owner of this propertyto perform the work for which application is made, <br /> ,nd I comply with the State Contractors Law 18,27 ROW and 296.200A WAG.'S 4/4* , " City ofEvereit Official Use Only <br /> PERM T# <br /> .12e. <br /> ..+ ; Date (Revised 5/201201h) <br /> etnnruse heriZedAcientSign5ture <br />