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11111 <br /> 477- PERMIT APPLICATION <br /> BUILDING/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 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> tO tt+fl 74iarL'.`llc'Ilitt74640 ie 4lW41 ` ` 104 _ ._.Urtt of $4$1. <br /> PROJECT SITE ADDRESS:85-19- -: C� _PROPERTY TAX#: <br /> LEGAL for new construction: Short Platfsubdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: SF. t t kot jj �r Coda Lou.�aei$L. TENANT NAME(If Commercial): ?)+- 010,43t r 4( Ct0-,C,n.e c & <br /> OWNER MAILING ADDRESS: STREET 85(?' 7144 it\te- 5t., <br /> '� CITY 006{,44.4" STATE (,JA ZIP 985 <br /> OWNER PHONE: (�/\ 9) ,L J, " 4 6,. . .l _._.....,.. OWNER EMAIL. ilik_.. Q��C(`J ..Oio_.... . . _..,..,. .M <br /> CONTRACTOR NAME: Kinpi'S --erx. too kc.. <br /> CONTRACTOR ADDRESS: STREET Caq 3 3!(./ 9- u6 , u7 It C <br /> CITY �l n(�C.)f10 d STATE LA/A- ! f ZIP C3(S2 <br /> CONTRACTOR PHONE: f-( ) - )¶ CONTRACTOR EMAIL: 61 i ore a N kts\A f(t y, _� <br /> CONTRACTOR LICENSE#(REQUIRED): )N65 0l Oi-i 14S A CITY OF EVERETT BUSINESS LICENSE#( QUIRED): �S"6 <br /> PRIMARY CONTACT: 'OWNER D CONTRACTOR 0 OTHER(Please Specify) <br /> CONT NAME: CONTACT PHONE: ti,as--) -sCe -....*1 i 6 <br /> rQ ll� F(5L e-( CONTACT EMAIL: <br /> Y`[f � �?ciiib\,, ore) <br /> , ::,. .:.. _ yVa - ft iCPTOI , ,WOIO :- .1:2011%r. i x <br /> I <br /> Existing Use of Building: C.,f\()rZt.\ Contract Price of Work:$ 3,L!00 <br /> Proposed Use of Building: Heat Source: kiGas CI Electric ❑Other <br /> Building Type: ❑SFR-Detached CI SFR-Attached 0Duplex ❑Multi-Family#of Units: gCommerciai CI Industrial <br /> Type of Project: ONew DAddition DRemodel ,Repair DTI. DSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: f <br /> f t.ep l&t.%t (1-b 1 U(t�Q.C2 1;11-t Tb k ( t , -- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 3 ,.: S a t q Mcg z v y.. .a,n,.... `} <br /> le <br /> . Type of Project: ,,New_ Addn Alteration Repair Type of Project: _New _Addn Alteration Repair <br /> #of #°f List of Fixtures 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 /> I 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 /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:!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;.cal law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> c ilding Official .fore•-i r authorized• de any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> d 1 ,mply it the-ta Co r cto aw{8.27-�1 and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> 1 /l6 PERMIT# 60� W1Owner/Author zed Agent ignature Date (Revised'92 016) <br />