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PERMIT APPLICATION
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<br /> BUILDING I MECHANICAL/PLUMBING 1 SIGN I SPRINKLER I DEMOLITION
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> - 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@evere#twa.gov I www.evere#iwa.gov/permits
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<br /> PROJECT SITE ADDRESS: PROPERTY TAX#:
<br /> oI Fi�F.����,�� �> 2Bos"©7003Cc,/ 00
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ?REIRWINNEENMIESVSICEEESEIBTMDIIIOAWKOTAKKOOAITOIMINNNHSNSEOIRMIRLNNESEIEIENE
<br /> OWNER NAME: Co L un-(6 i 4 C 44504be Pctnpy I./A-TENANT NAME(if Commercial):Mee L.4 F Gi POniin)0
<br /> OWNER MAILING ADDRESS: STREET Pa 60„1/4 ?90930/ /�
<br /> CITY 54 finypo u 1 TA 78. ..?_
<br /> t / STATE ZAP -W/
<br /> OWNER PHONE: 1\I Jr). 'OWNER EMAIL:
<br /> CONTRACTOR NAME: NOeat, 134,,,L0 p(-2,✓7li"I 6 .{ j'IVa rIr•1u l v7i,1-'yVis-16
<br /> CONTRACTOR ADDRESS: STREETy��1 'Lj y��S ef S IV 'dx)e S,
<br /> CITY I )CP(%LY 046"Ja STATE 11/4 /�n( e ZIP `! e d cif—
<br /> CONTRACTOR PHONE: e-47,3-- 6 q 8-332 i p CONTRACTOR EMAIL:�21tii�/r0 At t»$i a 6 F1 61741 L,G 6,1
<br /> CONTRACTOR LICENSE#(REQUIRED): Nov, aro Ti e•3-1( IT
<br /> CRY OF EVERETT BUSINESS LICENSE#(REQUIRED):(Lig,'L et
<br /> PRIMARY CONTACT: ❑OWNER "CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: Py,� Flet End, CONTACT PHONE: G ,S-6-96-332)
<br /> CONTACT EMAIL: Noisy,/ II',p Pwn,SiN, 2 K/Y/>a,"(.e,.y
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<br /> Existing Use of Building: Pi 2 2,. rftMee u.�— Contract Price of Work:$ v— 'O CD , ' —
<br /> Proposed Use of Building: 6 e4.00_,,6 e Heat Source: Lias ❑Electric DOther
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached CIDuplex ❑Multi-Family-#of Units: igiCommercial ❑Industrial
<br /> Type of Project: ['New ©Addition ❑Remodel IEIEtepair CIT.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: p G 1 NSA�g„. F.0, o a_6.s -.t N I%,,,,) w fr4 7/5� t-Y fro j K.
<br /> r$Fre-a- 5,17 ox /W o-rf-2 • N. a "I' - PLe/v"6 1..)(;
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): V 1 6 6 3 c5 6--0
<br /> wpc�n. Ar�A/�iy t^ ��yy�� �a�. A .M...� .. _ ®■ �p X11 ■■[r.�{p�C 1p■ �A B�® np�. 'i
<br /> 1-...,3,.:_3:IIf1i -ooj 6CMb IC_"RlYl Tt,lfl itot st—o�±. .'.+_t'.+ ��...,1.1-.._:S'�:":�"ssG�. T.,a.Viv,1B*-4At IM,•Il l9P UcA•'.IvL Nil X ,v.:,. -._-_,s-.'.. :-_
<br /> Type of Project: New_ Addn Alteration Repair Type of Project: New _Addn Alteration ,Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> • NC—Air Handling Units Heat Pump ( Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler s I Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal I Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan i Sink(Service/Bar/Mop/etc.) Other: (i
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true 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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAG.
<br /> City of Everett Official Use Only li
<br /> PERMIT#
<br /> /a�y� � ' 130`-(— ®2 (
<br /> Owner/Authorized •gent -.n. - Date (Revised 10/12/2015)
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