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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> gr. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:. q 14 <br /> ,57.0.,-res;--1 Neil atlt Tguir r: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ittagaiMeMpearSKROIRMIIMMISMOONTAOTiINFORMA. iON ,,, <br /> OWNER NAME: Meet VZ.._ P-f ti�ilM/ y- TENANT NAME(If Commercial): (/$k'. <br /> OWNER MAILING ADDRESS: STREET Zq/ ,S! Q'T� <br /> /9U(_tr �e&z7 <br /> OWNER PHONE: ?�SO fj/2 z�j OWNER EMAIL: N^u� T 'I,v _ -(aY ..517WieRA„,a) <br /> CONTRACTOR NAME: ( �-V' �T (pi) 7 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> r 1 CONTACTpME: r 'ONTACT PHONE: "?....S)G 5 1 537 1 <br /> C/U/p( 5.64,A4 ONTACT EMAIL: / 5/tic lJ"t___Scx( <br /> eA).9rl i(, <br /> "' ` k " B,U,ILDING)PERMIT APPLICATIONIlitataganig <br /> 0 <br /> 14t23 ,(� <br /> Existing Use of Building: f, 3 t/tLO Y f c 2 t1 Contract Price of Work:$ 1 o t3, <br /> Proposed Use of Building: 2( A.11 V\T/P/72ii2•, Heat Source: ❑Gas %Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New 0Addition ❑Remodel El Repair ❑T.1. !]Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ; r wee r7 ' �e/ ae f'5 <br /> tt <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 11-03-6,MECINAPOCACI#ERMIT*0.1kOdATIONMIN OffigagEangOLUMBIIINGIOORMITWPRI41AtIONSIMEMNIN <br /> Type of Project: __New_ Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of #of #of #of S <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures a <br /> AiC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace - Wood Stove Kitchen Sink&Disposal 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 Sink(Service/Bar/Mop/etc.) Other: <br /> Al4A11*illt*LEIti4APPRRE*§11PlisysTeiyikOkeq <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 I comply wit. °State ontractors Law 18.27: • -•• -. . :. AC. <br /> City of Everett Official Use Only <br /> ✓ pp✓ Z1 PERMIT#b.--10 <br /> 0t4, <br /> 401,17iC1!Agent Signature Date ( (Revised 10/12/2015) <br /> 19 <br />