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PERMIT APPLICATION <br /> BUILDING i MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-267-8857 i(E)everetteps@everettwa.gov I www.everettwa.gov/permits . <br /> . <br /> (U(ue ctr 1mmack titic®n13t. fuse) • PROJECT SITE INE®Ritl1A1IOIN . <br /> PROJECT SITE ADDRESS: ('Z 3 Ce.mi,r.a AV-r-; !PROPERTY TAX#: ' <br /> LEGAL for new construcflon: Short Plat/subdivfsion Lot No, (attach copy of long legal description) <br /> • - . '. . . . ..00tailta'TINEORMr T1e l • . ' • . . . <br /> OWNER NAME: L (( .Co i MA C ( /\- TENANT NAME(If Commercial): <br /> OWNER MAiLING ADDRESS: sTREEr 6z. �4tV ��`�r� • <br /> CIN ev STATE 624 ZIPfg <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: EUb'.Z.C4-t A J .•.5` -A--rtf "jfECerWI A--c. ,. .....a. x x....,.... .v_. ... <br /> CONTRACTOR ADDRESS: STREET '2-1 9.0 Cil AU a <br /> .0A <br /> eny . STATE u 4- zip 6t€32.o f <br /> CONTRACTOR PHONE: 416-2.51-5/1(f • 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): aS12..6.,jS ozzp T• clTY OF EVERETTBUSINESS ucENSE#(REQUIRED): 06 r '5- <br /> PRIMARY <br /> PRIMARY CONTACT: 0 OWNER I .CONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: 4 Z 5- 5'z--,//('G <br /> Ke.?..) 6"4 1....45 CONTACT EMAiL: k' �4 5lI/ Wet.0044 <br /> • - • <br /> ' <br /> Existing Use of Building: <br /> �UI1.D►Id�P RI'IJT P!><CA`T�OM <br /> i (ConFamily#tract Price of Work:$ /' 1 �� , <br /> Proposed Use of Building: Heat Source: Gas L fedi-to ©Other <br /> Building Type: FR Detached L1SFR Attached L7Dupfex QMufft Units: °Commercial °Industrial <br /> Type of Project: ONew °Addition °Remodel °Repair DT.I. CISfgn °Sprinkler °Demolition °Change of Use <br /> DESCRIPTION OF WORK:T L.L- v Re.a.11j4-CL rt Li' .T P <br /> ASSOCIATED BUILDING PERMIT Cif applicable): <br /> 1VieC$ ,AANkcAI.PI ;bM1TAlaPW.ICAT1O I . ' • • . PISUM6IMG liolagellit APPLICATION <br /> Type of Project: __New Addn Alteration_Repair Type of Project: New Addn Alteration Repair <br /> °f List of Fixtures °f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units J Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> 1 Forced Air Systems Unit Heater Bathtub Urinal • <br /> Gas Piping Boller 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 /> •SPRIR11 fL)E1 /SUPPREWON SYSTEIVi <br /> iNumber of Heads • <br /> ACKNOWLEDGEMENT'Mayo 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 locallaw,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,ori am authorized by the owner of this property to perform the work for which application Is made, <br /> and l comply with the fate Contractor 18.27 ROW and 296.200A WAC. <br /> i /,. City of Everett Official Use Only <br /> (i/ d <br /> IPERr\ leroLi <br /> Owner/Authorized Agent Signature Date Revise 6/20/201 <br />