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CANNED <br /> PERMIT APPLICATION <br /> •---BUILDINGJ.JhICI-IANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> Otr-l!......_ C1-`Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everetiwa.gov/permifs <br /> (kilos.®r olstcik Mk ®.it( '•Plese) ' • • PROJECT SII:Tt iNFORlllIATION .. • • . <br /> q f 0 7 • •rte- 7PROPERTY TAX#: ' <br /> PROJECT5ITEADDRESS: 'c1 <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> - : . . ' A <br /> .•CONTACT ik iF®RM,ATI®N . •. . .• '• ' . . .• <br /> OWNER NAME: ./AIM� r t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET / -/0 yamf4 <br /> A..:-• Ar i' ' <br /> r/CITY kt .�G( m STATE - ZIP ` / <br /> OWNER PHONE:( l G...3 , Leis.. .s—.OWNER EMAIL:.. ., ..,., .....,,.r..,.. .. .� ,....._...,.. . _.._. ... M,... .. <br /> CONTRACTOR NAME: C U .0 ad 6 7-71A-171- WLR <br /> CONTRACTOR ADDRESS: "'ear "4-1 te <br /> [ l AU <br /> Cr' r:� <br /> ' URitriT STATE (,t,/.- ZIP iS20/ <br /> CONTRACTOR PHONE: 4'252-52'.5IIq • 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Ea.42.65$®2.`o'I. jciTV OF EVERETT BUSINESS LICENSE#(REQUIRED): L9 6 r ' <br /> PRIMARY CONTACT: 0 OWNER °.CONTRACTOR El OTHER(Please Specify) ' <br /> CONTACT NAME: CONTACT PHONE: 4 7 5.-2-5'2°•,i/9 <br /> 4- CU:p CONTACT EMAiL: , <br /> . `, • �C1II.> IIdC9 PRIIIII'>t'Ld��LfC�iii®I�t <br /> Existing Use of Building: i Contract Price of Work:$ 6J <br /> Proposed Use of B Hiding: Heat Source: Gas °Elecfdc °Other <br /> Building Type: FR-Detached OSFR Attached�_°Duplex °Matti Family i of Unifs: ❑Commercial C7lndusfrial <br /> Type of Project: °New °Addition °Remodel Rk3.epair DTI, °Sign DSprrnkler ❑Demolition °Change of Use <br /> DESCRIPTION OF WORK: Boit '-3' 2 f • . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • ' :IVI.6CIC1A1 1CAL P Rt1/I1T APPI.IOI T___ION. , I . • . . PLUIVi1 IHG PeBI'I1`P APPA IICATION • <br /> Type of Project: _New Addn Alteration Repair Type of Project: New Addn Alteration __Repair <br /> #of List of Fixtures N of List of Fixtures #of list of Fixtures #of List of Fixtures , <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–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 /> :•SEignI .I R• / Y�Ii.PRESSt®R9 SYSTEIV1 <br /> _ INumber 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 underany circumstance.lam the owner,or!em authorized by the owner of fhls property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> . /f w f'1 1 PERM a0(4. , ,l - <br /> Owner/Authorized gent Signature Date (Revised 6/20/2018) . <br />