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I <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER I DEMOLITION <br /> slegriCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Bk e'=or Black JOk Only Plea's"e) `'l O JEC ',Sl'It 1NIFORMATIIOi ._. ` .- `W <br /> PROJECT SITE ADDRESS: .2410 0 ighielth4 AVei PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ...� :.. = _ , •'GONTAGTf II±IFORMAirliii . - k-w g .... <br /> OWNER NAME: 1v j d MArt fardfi TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET mit, n{gin iaytl Ave" 7 <br /> CITY E♦ � 2 it STATE WA ZIP O [ <br /> OWNER PHONE: 142G—�ti-k—0140' OWNER EMAIL: <br /> CONTRACTOR NAME: irtzarttolgicte, ifS VtDMai <br /> CONTRACTOR ADDRESS: sTagET I22-C1 i i 1,011A y+ ‘11/ S W"i"a., ) <br /> CITY Lynrw on d STATE INA ZIP q t -.- <br /> CONTRACTOR PHONE: 42„cj--Mr — 61-1314aEMAIL: tttrinrUtAn4ho Iii@ •h,oia.CO <br /> CONTRACTOR LICENSE#(REQUIRED): s�++A n F•T�Li�U(�f_ <br /> �t c7 sC+ CITY OF EVERETT BUSINESS LICENSE#(REQlliRE i : 04o'q t <br /> PRIMARY CONTACT: liCOWNER O CONTRACTORO OTHER(Please Specify) <br /> CONTACT NAME: einus c �r�j, CONTACT PHONE: M 2 —.pi .1,434 <br /> CONTACT EMAIL: hibar rit -iu I LA q kkOO•Cieith <br /> F :F ..,'. B ilL-DiHO _:,OTO.OV AT,ICItt°�':" 2F., a r <br /> Existin.LUse of Buildin : IYbjle,�Ir»i1H _ , `Contract Priee of work: Zec'tric <br /> •..�. �� -,. �� �: _,.:� -,rte.-.g 9 S •ProposedUseofBuilding: �l L.tj f Mi lyHeatSource: Gas ❑ O•her <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: OCo' mercial El Industrial <br /> Type of Project: ❑New iialAddition El Remodel ORepair OT.I. ❑Sign OSprinkler ► tern•''. OChange of Use <br /> DESCRIPTION OF WORK: %fit Bas lige, I'D 'i 1oc t oK qli in 0mM spq'cao• D ict,t lio t Witte <br /> itte <br /> 1 *. macs nhi f t replan <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> `.''' '',;N:4;-.0/.00.A,HAN1CA.4EROtt,400,040 T!ON . . to ` . .. . "',i PIr,1JMI0L ER11 ##'. LCC ,1 ,1 ` ' n , <br /> ;Type of Project:. New Addn _Alteration Repair Type of Project: _New _Addn Alteration Repair <br /> #of #of #of #of <br /> Fixtures Fixtures of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 14 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> I Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting J Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan — Sink(Service/Bar/Mop/etc.) Other: <br /> Chemical or Water No.of Heads 1 <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 befor being authorized under any circumstance.I am the owner.or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> end I comply with State Contractors Law 1 '' C. -- r 200A WAC. <br /> City of Everett Official Use Only <br /> t t 17 17 PERT .i..-q, <br /> (` - 64.5 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />