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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL l PLUMBING I SIGN I SPRINKLER I DEMOLITION
<br /> CITY OF EUERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERET,WA
<br /> (P)425-257-8810 1 FAX 425-257-8857 l(E)e*ps eve ettwa_gov J ww veverettwa. rlperrrtit$.
<br /> •
<br /> 1134M0-4*Black 1 OIn1 3P1ee .:11R C c 1TE[ ORMA 4x ,.r
<br /> PROJECT SITE ADDRESS; 'c 5— Otyme3c hr. PROPERTY TAx .O&3 6!1100300
<br /> LEGAL fare new constructicm. Short Plat/subdivision. ,_, .'t al 2 61a t No. (attach copy of long legal description)
<br /> OWNER NAME: L i II Jl� s TENANT NAME(If Commercial): Cr/kw/if/2nL14t•f
<br /> OWNER.MAILING ADDRESS: STREET" c2 CJ,/ 1/ � Se07S
<br /> cera b k orA, r� Yeas-3
<br /> OWNER PHONE 830 tQ 0110 OWNER EMAILWG.S+ Tap e. co0A.
<br /> CONTRACTOR NAME: et e,4 , (e,i y x.; 41 /J LI
<br /> CONTRACTOR ADDRESS: s ear l-�4�.-') ac r e S r%!,
<br /> CITE' (.;.0
<br /> '`"" ✓i i &TATE Ino 0 ZIP 7p
<br /> CONTRACTOR PHONE:3 {ry t $-7/03 CONTRACTOR EMAIL: CutAt'1 t' S 6 alit.cQ1VL UCENSE4RREauir. -n) ,, `s d.wec"9&3 c3TY )F EVERET TJ BUSINESS LICENSE#(REE UIRED) i" , lg1;A D
<br /> CONTRACTOR i r
<br /> PRIMARRY CONTACT: g OWNER a CONTRACTOR CI Specify)
<br /> Olt-
<br /> CONTACT NAME: CONTACT aA PHONE: I
<br /> 4746' ' c 0- fr,13
<br /> 4.2"-
<br /> ." LTDr ig C#iNTACTEMAIL: rA.rar' } ,.e; < S e81,4x4Cam , < 4 all
<br /> Edsting Use of Building: Kz.Si; i+X iSi t c.€j G ---- Contract Price of Work: t' !'° 4°, 4 A
<br /> Proposed Use of Building: SAti..c- $ 4py?c,,, Heat Source: OGas OElecttic ClOther
<br /> Building Type: ®SFR-Detached OSFR-Attached CIDu lex CIMuiti-Family-#of.Unit OCorhmerc ial Ilindusbfal
<br /> Type of Project:: ONew, .. Addition °Remodel DRepair ©TA, OSign l ISSprinkier °Demolit on OChange of Use
<br /> DESCRIPTION N OF WORK:7-ew- Cool F rvs1 2.'t 6'k -4,g,,,+"r, 1145 ' (-er +ositi -
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> 1, MEfr`"r .. ii`RMi PP 1„t"�sAT1 �- ` P`k. ME4 41 M APPI c .O - .X 7
<br /> 'Type of Project: New Rolan Attention _,,,Repair Type of Project, _New Addn s n Repair
<br /> Pa. ' #of #of #of '
<br /> List of FixturesList of Fixtures List of Fixtures List of l ures
<br /> Flxtnres fixtures ';Fixtures' ,.4 '.
<br /> A/C-Air Handling Units Heat Pump - Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems unit Heat Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash>5a Dr- F .intain
<br /> • Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace; / Wood Stove Kitchen Si : Disposal se Trap`
<br /> Gas Range ,// DuctingDis . . Roof Drains
<br /> Clothes Dryer Hookups ~Other: CIo - Washer Medical Gas
<br /> Range Hood /
<br /> W. -r Heater Other.
<br /> Exhaust Fan _ 'Sink(Sery ce/Bar!Mvk lete.) Other
<br /> ;SP 11 ERJ SUPPR !IIQ R'1 ;AM,, ;
<br /> Chemical or Water 1 No.of Heads
<br /> ACKNOWLEDGEMENT"I have reviewed this application and confirm the information contained herein otic true and correct;worn done pursuant to this pert)*Must complyulth
<br /> current federal,state,and local law.The grantingicf spat-ma-only authorizes approved work and no deviations therefrom.Deviations crust forst be authorized in writing tram the
<br /> Building Official before being authorized:under any circumstance.lam the owner;or lam authorized by the owner of this ptdperty to"'Mbar the warn for which application ia made,.
<br /> and l oomply with the State ontma R:,,Law 78 27 RCW and 296.2004 WAS:.
<br /> ,,f City of Everett dial Use Only
<br /> 4). //,/
<br /> r 10 /eOS\:%0 9
<br /> , ,
<br /> Owner/Autho Signature Date - (Revised 9/23/2016)
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