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PERMIT APPLICATION <br /> ;! BUILDING/MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> " i- CITY OF EVERETT PERMIT SERVICES <br /> c"v'•.7 ,,,t,,/:,:i i 7 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everetiwa.gov I www.everettwa.gov/permits <br /> IIPRO(614:4',0..I I C1 'b6 ii.Oti hi 03. is®) PAO, 1 CT tuTg IIN©RIVIA`li Q®1N4 . • : . . ... . • • . .•.• .. •f <br /> PROJECT SITE ADDRESS: 0 0tr17/L gCr A./4-. - <br /> PERTYTAX#: <br /> LEGAL for new construction: Short Plat/subdivision ppaa ��}y �a p�}�Lot No. q. �pp(attach copy of long legal description) { <br /> OWNER NAME: sob lt4t}(',Air TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTama' 605 6../074/1011k', /4110 <br /> - cny L''Ut-_L., — /STATE I.A.A. ZIP !6��>� <br /> OWNER PHONE: ^.z456.3,-.,. '.1 I OWNER EMAIL:... . , ./VL..4 .. .... .., ..A... <br /> CONTRACTOR NAME: 1�7L,=(ZaILS Ct�i1x c ,iL <br /> CONTRACTOR ADDRESS: STREET 2..t Zo PA L <br /> Crit F/u'�lr.-E l-1 STATE LOA ZIP q c'2 C <br /> CONTRACTOR PHONE: HIS) 252-- 3((1.- CONTRACTOR EMAIL: 1-2-0-14.0,,g--%VII ram <br /> CONTRACTOR LICENSE#(REQUIRED): G1?QZ0,gc f]" -r— pw ICITY OF EVERETT BUSINESS LICENSE#(REOLIIRED): 0.6 /j- <br /> PRIMARY CONTACT: El OWNER XCONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (tits) 5Z� <br /> 51,e 7 <br /> tLe(� CONTACT EMAIL: \ ,(,,t.,-`p. a 6'57Y1LL.rr...6►614 <br /> •. `•�'' .• ' =BUILDING RBFiMt`T;AARK.I. ,TION • . <br /> Existing Use of Building: /Contract Price of Work:$ 3,. �f ct <br /> -Proposed Use of Building: Heat Source: [(Gas VIElectric ❑Other <br /> Building Type: OSFR-Detached ❑SFR Attached [(Duplex ❑Multi-Family-#of Units:, ElCommercial ❑industrial <br /> Type of Project: El New IIAddition AlRernodel [(Repair JJT.t. CDSIgn [(Sprinkler ElDemolition ElChange of Use • <br /> DESCRIPTION OF WORK: t-jittt 6.1) (e+t NLCr 5 `3 <br /> • <br /> ASSOCIATED BUILDING PERMIT# if a•plicable): - _ , <br /> ,:......MgCHHA JCA:P?ERIiikI PPLICATI N• ' • , Pili. WII l®.P1 kMItAtkr `fit ION <br /> Type of Project: _•New Addn Alteration Repair i Type of Project: New Addn Alteration _Repair <br /> #k of #of #hof #of <br /> Fixtures List of.Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> i <br /> ( NC—Air Handling Units ( Heat Pump Toilet Backflow Preventer(inside Bidg) <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/Map/etc.) Other: <br /> ::::'n..;.:. SPR 1I 100-•,/.S UPPP SS10I SYS` `E•Ilil,. <br /> }Number of Heads I <br /> ACKNOWLEDGEMENT.'/have reviewed this application and confirm the Information contained herein Is tme 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,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> I PERMIT#1` 17 ® Cp i <br /> y <br /> OwnarlAut'7prized Agent Signature Date (Revised 5/20/2096) <br />