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44"/-rPERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8310 i FAX 425-257-8857 I(E)everetteos(gkeverettwa.gov I www.everettwa.goviperm s <br /> (Blue r r'Black Ink'Only Please) PRC3J GT+ I lIt Et}th/I t°t ON.'`W2` <br /> PROJECT SITE ADDRESS: 453 W,. a A <br /> u' # 4 Z <br /> LEGAL for new construction. Short Platlst.rbdl,eisinn PROPERTY TAX#. <br /> ---. Lot No.� (attach copy of long legal description) <br /> CONTACT=INFORMATION , . <br /> OWNER NAME: 4t�ir.,"" rr � 0� <br /> 416, <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: <br /> ° ., r► <br /> ,. ""' <br /> OWNER PHONE: t # • <br /> '' �' 0(6 � �► OWNER EMAiL: <br /> CONTRACTOR NAME: 9 <br /> CONTRACTOR ADDRESS: ;ra==Tforact ___ <br /> 01.CITY 0 <br /> ajct STATE A P1-- Lia dr w . P <br /> CONTRACTOR PHONE: 2F-j q 0 <br /> 50 CONTRACTOR EMAILso A 4 `"+ " -AAA .a,0 I fl' ,.COfll <br /> 0ONTRACTC FI-L4CE ESE tREDUIRED)' - <br /> R ' -, <br /> �.#1r1. W <br /> T�- *` " cI't9rr+esrLuslNess-4ICEressE IS(REQtnREDIT_4jD6S,r _.g...___ <br /> PRIMARY CONTACT: 0 OWNER t/CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> LSC J - e)CONTACT PHONE: Li.� •2,6 25q QC�,f,,,tz) <br /> CONTACT EMAIL: (10 a e Cc kec'+! .CD fl/j <br /> Existin Use of Building: <br /> Contract Price of Work:$ • • aw 41 <br /> Proposed Use of Buildin <br /> Ruitdan Type; ❑SFR-Detached ©SFR-Attached iHeat Source. ❑Gas CO-ctric DO her <br /> _�,_. <br /> �Ouo�t C1Muii-Farn[I -#of LkntCs. <br /> Type of Projet'; ONew D_.., -_ ©Commercial [Industrial i <br /> ❑Addition DRernodei Repair ❑T.I l - �ry <br /> OE3CRiPTION OF WORK: <br /> r n �Sdrsrtlyr L 1�arTJiif[�i1 ❑CI�ai�eofUse <br /> AS4iOCIATED BUILDING PERMIT#(if a ulica,ylej; '8� S <br /> 1NECHAAIiCAL'PEft1VIIT AI'f'1;lCtt7tON , <br /> , 'I:UMI3NC;r'pRM1 `t1P!?L(CATtON <br /> Type of Project: New <br /> Addn Alteration Repair <br /> —eija i_t.oCFlxturos-_...�. 4 o7 Type of Project: New `Addn Alteration Repair <br /> S Curds f;of nr.F-ztuxes-- 'f.._.,_ --ListerFixfures if of _ 1 <br /> A/C—Air HandlingFixtures Fixtures tfsf of FixrurQs- I <br /> 1111111111 Units T r�i[et <br /> Forced Air Systems Sackitow Preventer Insid LId <br /> Gas Piping Bathtub Urinal <br /> alliell n Boiler Lavatory(Wash Basin <br /> �Refrlgeration Floor <br /> Drinking Fountain <br /> Shower DrainGas FireplaceIIIIIIIIIIEEMIEMINIMN <br /> 11.11111.Gas Rance Wood Stove Kitchen Sink&Ois.csal <br /> Clothes11.11111111. Dryer Hookups Dishwasher Grease in <br /> Clothes Washer MRedif Drains <br /> s <br /> MIN�n e Hood Other: Gas <br /> P,a � Water Heater <br /> 111. Sink(Service/Earitvlooietc. Other:=III O#her: <br /> .. SPRINKLER"SUPPRESSION-SYSTEM <br /> Chemicai or Water <br /> No.of Heads <br /> ACKNOWLEDGEMENT 1 have reviewed this application and confirm the information ccnlained herein Is true and correct. Work done pursuant to thisermit must <br /> current federal,stale,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized <br /> O�cia1 before being authorized under any circumstance.i am the owner,cr i am authorized by the owner cf this property to perform the work Pized in writing from the <br /> r which crmpo h. <br /> and I comply with the State Contractors Law 18.27 RC W and 296.2GOA WAC, <br /> FF cotin is made. <br /> City of Everett Official Lisa Cray <br /> .z+/ PERMIT# _jili � <br /> Ow.or/Authorized Age ..tom`. _ r —7 t�a I I Aj 4 I <br /> g Signature 1 l t_/ I6 Jl/]ti11 <br /> Date Osvised9f20i6) <br />