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PERMIT APPLICATION
<br /> ••• ,+ BUILDING I(MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLiTION •
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> T 3200 CEDAR STREET,EVERETT,WA 98201
<br /> ._ (P)426-257-8810 j FAX 425-257-8857 j(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits .
<br /> (hIr,Le'®r hialac Ink®.n13 pie6a) • - " P1 ?J T tk,It 1mRnh1A`PIDM •• • .
<br /> PROJECT SITE ADDRESS: 2-6,6-2_ \Jt (_c iZ,5•T AVE-, PROPERTY TAX t#: '
<br /> LEGAL.for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description)
<br /> • - . _ . . .ce tTACT,111 iPo Tko? .
<br /> OWNER NAME: Ruin Athc2 TENANT NAME(If Commercial):
<br /> •
<br /> OWNER MAILING ADDRESS: STREET ioZ 1/(c-(,.-3 4v6 ���/� •
<br /> CITY (..v�Q. '" STATE WA _ ZIP f0 GtJ3 '
<br /> OWNER PHONE: Lac g,5��_ L (e ,_ ..._....,,...� _ OWNER EMAIL:...., ..... „d.. .� .,,...» _.. .
<br /> CONTRACTOR NAME: E U Cia6MAJ 6T'fOr ar e`rC Wt
<br /> CONTRACTOR ADDRESS: STREET '24`fit) fi t pt. AU er .
<br /> any .0U612- STATE (,&4-. ZIP /Z`7°4/'i
<br /> CONTRACTOR PHONE: °�5f� 2-3!1 (CONTRACTOR EMAiL: bi tA•GL��rt(,tela/O./'�1�.45r,ti 7
<br /> CONTRACTOR LICENSE#(REQUIRED): E(, 5S&2 r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 436 '5-'m•
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<br /> PRIMARY CONTACT: 0 OWNER I LCONTRACTOR 0
<br /> OTHER(Please Specify) •
<br /> CONTACT NAME: ? CONTACT PHONE: 4 7C-X2 5' -5//9
<br /> •
<br /> ()kLe CONTACT EMAIL: /41,-1 49 e$.�f'g)t e.ia.e0. -• • .'. BUILDING PtRM1T APDL idA�i r.Oii •. . .
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<br /> Existing Use of Building: f Contract Price of Work:$_IY,7,_657!,
<br /> Proposed Use ofB,uilding: Heat Source: l ,Gas CfElectric (]Other
<br /> Building Type: SFR Detached OSFR-Attached C1Duplex °Multi-Family-#of Units: ❑Commercial DIndusfrfai
<br /> Type of Project: °New °Addition C(Remodef ❑Repair OT,!. °SIgn °Sprinkler °Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: i Cli �, Add
<br /> CA�NC ' 6C4-1- ('Q/!S l ulblCr✓ c1J/Cv Ul!'iLxYr4'� �^'�
<br /> ASSOCIATED BUILDING PERMIT 4 if a•'licable:
<br /> MEC4ANIOAL..,PBRIVII`I'APPLICATION I . • • • . PkuN1AJNo PERf1t11T ADPL IIOATION •
<br /> Type of Project NeW Addn Alteration__,Repair j Type of Project New Addn Alteration Repair
<br /> #of List of Fixtures #of LIS'of Fixtures #of List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC--Air Handling Units 1 Heat Pump Toilet Backflow Preventer(inside Bldg)
<br /> I Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boller Lavatory(Wash Basin) Drinking Fountain
<br /> 1.
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal • Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains I
<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 /> •Sfii!' 9 (LER/WipRBS IOW SYSTEM 1
<br /> t 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.I am the owner,ort am authorized by the owner of this property to perform the work for which application Is made,
<br /> and/comply with the State Contractors Law 18,27RCW end 296.200A WAG.
<br /> 4...‘„, 6:1,4) City of Everett Official Use Only
<br /> PERMIT#
<br /> )6'‘
<br /> )wner/AuthorAgent A ent Signature Date (Revised 6/20/2018)
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