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L <br /> PERMIT APPLICATION <br /> F d <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> �i.r"' ?� CITY OF EVERETT PERMIT SERVICES <br /> V A-4, ( 3200 CEDAR STREET,EVERETT,WA 98201 <br /> _ (P)425-257-8810 I FAX 425-257-8857 1.(E)everefteps@everettwa.5ov I www everet€wa govlpermlfs <br /> ito ' tt. i<ai.4 i!l P I P I.Ieas) PR.Q'JI CT 9't nJ IJF.-0 M l'l r. l . ' . <br /> 'PROPERTY TAX# <br /> PROJECT SITE ADDRESS: j t.1-j g.9-774, <br /> LEGAL for new consfruc on: Short Plat/subdivision Lot No. (attach dopy of long legal description) h <br /> : •' <br /> 450th 'pIi71 . 0 ....- 1...'-'.:e..-.:1 <br /> OWNER NAME: /2 jC: A.12,i) 5j TENANT NAME(If Commercial) <br /> OWNER 11/TAILING ADDRESS: STREET 3/ 61�g L'S: .-- , 1f C �j, <br /> CITY V SATE C,:�""`+ ZIP ?a)I <br /> 0411lNERPHONE, . .:r...`x (_ .1OINNEt EIUTArL; .,....:,. . a,...., .. <br /> CONTRACTOR NAM~! 6.9E.--(. E k • ttLT ,t`i <br /> CONTRACTOR ADDRESS: STREET 2,.6 ZO PA-k LC, <br /> t7rY 6)(..------:a4--r- <br /> STATE LOA fP eice2ti <br /> CONTRACTOR PHONE: i 25) 2- t('-4' !CONTRACTOR EMAIL: t• 0,, .G v+t,f.1 =dam <br /> f <br /> CITY OF EVERETT BUSINESS LICENSE t(REQUIR.ED}: og7 <br /> CONTRACTOR LICENSE#{REQllIR>�I]j -6J {2FJ�r <br /> PRIMARY CONTACT: 1_I OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( ' ) yog . ?i <br /> 1 I ' CONTACT EMAIL; >.c..4•0 5$1yEt-ell <br /> _..tai ttimt,.i? 1tlij`;A!'I? • _. .. <br /> Existing Use of Building. <br /> Contrast Price of Work:$ ,5(710), 0 . <br /> Proposed Use of Building: Heat Source: 91Gas L-lEiaofric ClOther _ <br /> Building Type: FR-Detached OSFR Attached 0Duplex EIMuiti-Family-#of Units: <br /> EICommercial Qlndusirial <br /> Type of Project: ElNew ElAdddittion E!Remodel [Nepali- j111. DSign EISprinkler IIDemoiition 1 Change of Use <br /> • <br /> DESCRIPTION OF WORK: t fspI : r 1x-r Ful., `,ir <br /> ASSOCIATED BUILDING PERMIT h (if a.•licable} — - = — — <br /> _ ,. 14A. 1t0 L iili:f it_014.410 :� PLU BUN R uT�40.P cAti. . <br /> Type of Project; __.•New Addn _Alteration _,_,Repair 1 Type of Project New Man Alteration , Repair <br /> of List of Fixturesf List ofFirtures <br /> t6 of List al:Fixtures #of i:;istofFixtures Fixtures <br /> [ Fixtures Fixtures <br /> Fixtures Backflow Preverifer(Inside Bldg) <br /> NG-Air Handling Units OM Heat Pomp Toilet <br /> Unit Heater'. Bathtub Urinal <br /> AMMO®®Forced Air Systems NUMT rinking Fountain <br /> Gas Piping i®.Bailer Lava tory(Wash Basin) <br /> Refrigeration Shower f=loor Drain <br /> WaterMINN • <br /> SIIMIIIIIIIIIWEMEEIIIIIIIIIIII Heater Kitchen Sink&Disposal Grease Trap <br /> Wood Stovep <br /> Gas Range i Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: "Clothes Washer Medical Gas <br /> Range Hood 1 <br /> ® Water Heater Other: <br /> Exhaust Fan I Sink(Service/Barll/top/etc.) Other. <br /> 'Si' 1a.gig*1 SU I'Ri S Q M O.irft-I4PI . <br /> `- - Number of Heads <br /> 4GKNQWLrO BILi have red this application eiowenn <br /> true toad <br /> correct,Work done pursuant to h <br /> :uinfederal, ,en al taw.Thdningoa perm lyathzesapproved work and no deviations therefrom,Deviations mustfi first be authorized n writing from the <br /> 3uiding Qf9eaibefore bekig authorizedunder any <br /> circumstance,l am the owner,ori am authorized by the owner of thisproperty to perform the work for which application to made) <br /> ,nd'i comply with the"State Contractors L 18.27 RCWand:29B200A WAC. Cth/of Everett Official Use Only • <br /> PERNI1T# -- D 5U <br /> ,r,nortdnfhnrazeelAgen�5lg ora <br /> ' Date (Revised 5 0/2018) <br />