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BUILDING / MECHANICAPLEIRMIT APPLICATION <br /> PLUMBING/SIGN I SPRINKLER/ DEMOLITION <br /> '414, <br /> ,44 ,iiirgi CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8657 1(E)everetteps@everettwa.gov 1 www.everettwa.govipermits <br /> (Blue or Black'IrileOnly Please) <br /> PROJECT SITE SITE ADDRESS: --. 41 1 2...... Lae.4 melt- 12-6 PROPERTY TAX#: <br /> LEGAL for new construction: Short Piatrsuodivision Lot No.: (attach copy of long legal description) <br /> CONTAC"r INFORMAtION <br /> t , <br /> OWNER NAME: Zdfip.KA e_. us Ica TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S.Ct t Z- 1,-Colg.k ervev- 12-4. <br /> CITY UUtiLet STATE V* ZIP 9 IS Zo?) <br /> OWNER PHONE: 20cr Z144 p5.5s DOWNER EMAIL: <br /> CONTRACTOR NAME: col 41 - fl In c <br /> CONTRACTOR ADDRESS: STREET 1 4 broctaut30..1 <br /> CITY Gs)DJ'.J t <br /> STATE A- zip qgzo1 <br /> CONTRACTOR PHONE: 42_5 2. 3ct 0550 JCONTRACTOR EMAIL'.,t..... 4 %, 11' AA ! ft a rig .cowl <br /> CaNTRACTGR-LICENSE#(fig:QUIRED):-C7-A -*-015R-4L---CtTY-OP'EVERETT BUSINESSAJCENSEI#REQUI J. <br /> RED`-fbfruil-g -- <br /> PRIMARY CONTACT: 0 OWNER 16ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 42.6 2.5C1 050 <br /> 1)0010 L-Q- <br /> CONTACT EMAIL:deAilo a e ketsat .CO ni <br /> - AitUlLDINWPERIVIltAPAIIIIII0 <br /> , <br /> Existin. Use of Buildin.: <br /> Contract Price of Work:$ IP •O .. , <br /> Pro osed Use of Building: <br /> Heat Source: 0Gas „Olectric 00ther <br /> Bulldin. T pe: r..PR-Detached OSFR-Attached 0Duplex 0Multi-Famlly-#of Units: 0Commerclal °Industrial <br /> T pe of Project: ONew °Addition ORemodel °Repair °T.I °Sign °Sprinkler 0 Demolition °Change of Use <br /> DESCRIPTION OF WORK: <br /> t 115kuU 1^ , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IVIECHANIdACPEilMIT APPLICATION ' - ' !' ''':'1'NA.110B$NEI,Ektifittir!APO,L4CATION <br /> ______Type of Project: New Addn Aiteratior-- Rei"7"-...."-' Type of Project: New Addn AlterationRepair <br /> #of ------------ir 07--------- t—j;%"---------"---37f"--------------- <br /> _rix,ttjrtn SIALEIxturee Fixture Litt of FixtureS, -rixtures List-ef Fixtiims-- List-of Fixture.s----- <br /> Fixtures <br /> NC-Air Handlin• Units Heal Pump Inside Bid )________ _- <br /> =9Forced Air Systems Unit Heater .Bathtuh UrirM-4----V--- <br /> as 19 -------fiTiiier-7--eater _______ ___ taLavatory(Wash Basin —"Dj-71.117-F-ouMr,fit- <br /> Waterefr. ,i era hon Shower ------TEOFMT-1 ----. <br /> ------G7sy—irepi "----- V-------- _______________2_ _ nKitchen Sink&DIs osal Gr, Trii ---- <br /> .....tar 1 e E91raDishwasher ----icroTI:TriTtf--------- <br /> Clothes D er Hookups , Other: Clothes __...Washer _—.7v1.;i3ical GMrs----------- <br /> _________--------R a n e l-- I 0 oc--- '------------ ___ Wa ter Heater__.._...._---dif <br /> Exhauster: <br /> f7a'r"-t---"----"--------____._.____ ________nk(Service/Bar/Mop/etc ---" ----- <br /> --'.---7711711"---757178.571Wi17----.40N SYSTEM -"----------"-----!'"--------- <br /> Cher - <br /> ACKNOWLEDGEMENT:I have reviNJo. of Heads <br /> ewed this application and confirm the Information contained herein Is true end correa Work done pursuant to this permit must comply with <br /> current federal,slate,and local law. The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in venting from the <br /> Boding Official before being authorized under any circumstance.I 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 295.200A WAC. <br /> City of Everett Official Use Only <br /> •ALI 01 ..tik,h,.... .".1 77iiZ-F----------- <br /> IA C:1 ( — sOLt <br /> ow,ar/Authorized Age Signature Dale <br /> (Revised 9/2312016) <br />