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'" PERMIT APPLICATION <br /> /', ,; BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> ` VCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)eve rettepsteverettwa gov I www everettwa.gov(permits <br /> Blue or°BlackinkR`Ot ly Please) 'PI OACT BI'IG; tINi='Oif i E C ',ION A't =rats' <br /> r <br /> PROJECT SITE ADDRESS: 3)9 ocAteasPROPERTY TAX <br /> LEGAL(or new construction: Short Platlsubdiv141on <br /> �Lot No.• (attach copy of long legal description) <br /> CONTAGT1NFORtVI;AION ' "" <br /> OWNER NAME: ` <br /> TENANT NAME(If Commercial) <br /> OWNER MAILING ADDRESS: STREET <br /> ( � ZIP <br /> CITY ek., Q��� STATE �Y <br /> OWNER PHONE: —4 ZS 2 '.`Ct le °l 'OWNER EMAIL: <br /> CONTRACTOR NAME: CIYI f In C <br /> CONTRACTOR ADDRESS: STREET I L+� QC. 7 S <br /> J <br /> CITY 'S% t* STATE v Pt- ZIP 0 I <br /> CONTRACTOR PHONE: 42_5 2 J o5SO CONTRACTOR EMAIL <br /> :6)04 1j e cuythia+ �1 .cord <br /> _---CONTRACTOR-LIG-DMB-#{RE@UIpEI ..CA/1 ./ <br /> - r �R - Crri:JP-EVERETT BUSINESSLICENSE'i REOUIREDy. �,,t Cy—Se- <br /> PRIMARY CONTACT: 0 OWNER ISCON 0 OTHER(Please Specify) <br /> CONTACT NAME: ^'A c^ CONTACT PHONE: 4-2 259' tet"-5�,D <br /> LYiC.+�J CONTACT EMAIL:duo&a oe JifY�ke,,A 1,, C.onl <br /> J, =arzuiLlyoottItIVl17=`Aofi`113If gr t Nal fr,r"95rAPg t <br /> Existin• Use of Buildln•: Contract Price of Work:$ s 2-D0 <br /> Proposed Use of Bu din _ _ .._. <br /> Heat Source: OGas DElectric ❑Other <br /> Buildin. T pa: SFR-Detached ❑SFR-Attached ❑Du#lex ❑Multi-Family-#of Units: <br /> y OCommercial ❑Industrial <br /> ape of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I VtiE*CI lx c u kip s k <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> f1lfECHANIGAI PERMIT APPLICATION <br /> ` , '`193.1I+NBiNCa kIVMI;f',t' 10,,:LIC'ATION <br /> Type of Project: New Addn Alteration Repair <br /> #of Type of Project: New Addn Alteration _Repair <br /> -Fixtures- _—... fsiof Fixture #of <br /> List R: to es..- _ .. #of #of <br /> Ores Fdx(ures 4lstOfFlxttiret --- ___.....___._„ -lost-+of-Fixtures — ..: <br /> A/C—Air HandlingUnits Heat Pump Fixtures <br /> Forced Air Systems F Toilet Urinal Preventer(inside Bidg) <br /> Unit Heater Bathtuta <br /> Gas Piping �E3ailer Urinal <br /> Water Heater Lavatory(Wash Basin) Floor r Fountain <br /> Refrigerat'[on Shower Floor Crain <br /> Gas Fireplace Wood Stave <br /> Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting <br /> Clothes O er Hraoku s Dishwasher Roof Drains <br /> Other: Clothes Washer Medical Gas <br /> Ran e Hood <br /> GxfTa�lst Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc, Other: <br /> SPRINKLER't-SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application end confirm the Information contained herein Is true and correct.Work done pursuant to(his 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.1 am the owner,or I am authorized by the owner of this property 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 /> Citytyof Everett Official Use Only <br /> �j "4U - a" I ` IPE I # � C�0�` 0� ( <br /> Ow,er/Authorized AgeSignature 1 <br /> Date * (Rdvlsed 9123/2016) <br />