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PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 l(E)everetteps@everettwa.gov I www everettwa govtpermds <br /> (BIue or;BJack 1r k tt+n►ly as+e.. .., I T$1 " � I t31 q* Ct <br /> PROJECT SITE ADDRESS:cia rat? -r---evracel 1 , PROPERTY TAX#: 00 7 SO) 500300 <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> ry M y <br /> OWNER NAME: oNo. A- 5 -.el,.‘..e.. TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 442, ,e)o Dye <br /> ere( E e1C4* STATE Cif/9 ZIP '"/ Cs <br /> • <br /> OWNER PHONE: L0 5-- p .(.. (41,5 OWNER EMAIL: (/ <br /> CONTRACTOR NAME: U .11,N.L.ilpf'i <br /> CONTRACTOR ADDRESS: STREET I Wel / f4-6P9 F re.. <br /> CnnY •(($ i, STATE ar k,gi^'p <br /> ZIP re r <br /> CONTRACTOR PHONE: 4 SS,- w- i � CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) A -73 6 630,4CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 5 f 1 3 9 <br /> PRIMARY CONTACT: i OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Loa 5 -2 3 Fr s"3 <br /> I' t`7 ` <br /> CONTACT EMAIL:. n,.L1,/ <br /> Existing Use of Building: Contract Price of Work:$ I I'C)0 _ <br /> Proposed Use of Building: Heat Source: Etas ,F EEtectric DOther <br /> Building Type: OSFR-Detached DSFR-Attached DDuplex OMuiti-Family-#of Units: OCommercial Dindustriai <br /> Type of Project [New DAddition DRemodel DRepair ❑T,i, OSign OSprinkler ODemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 12e p i 1 -- c, cr- ,t <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 4E0iEi,010A ?' ti`P 01#0.0 l*10ti! P > ' i4 4 <br /> Type of Project: _New___.. Addn Alteration Repair , Type of Project: New Addn _._Alteration _Repair <br /> #of List o€ xiures #of of <br /> Fixtures Fixtures List of Fixtures #FixturesFfxiures <br /> List of Fixtures #of List of 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 Lavatory(Wash Basin) Drinking Fountain <br /> I 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 /> PRIINS.4: 0 *WO.:..:WS) $„*Y.,$t* i;;%;,..,,., <br /> Chemical or Water I No.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 tam authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> F#� <br /> '-- - PER .1y)0 <br /> o3 1 `r O314 <br />