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101L- PERMIT APPLICATION ORIGINAL <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> ilir -r-''' 'Zr.'---IK'''Lr.---,h. r PRoJEOT-�SITroo-t MATt0 1, = is o ;; tY a 5"' ri <br /> PROJECT SITE ADDRESS:G /) yQ' rive J( (Qr PROPERTY TAX#: /��/� 140- /T/'�/�j i�Io O <br /> LEGAL for new construction: Short Plat/subdivision t�t )C� Lot No. (J (Q(attach copyof long legal description) <br /> �r � � �� - - r�.._� �..rte. <br /> 4 117§: E ' ril ` ,; 'i uig syr ( ONTACT iNFdRMATI N"'M I r G; OleM3 MVWv^ <br /> OWNER NAME: M,aYt(A 6-Ili/nook TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 47_li e1 1,6-141 nig 35 <br /> /�//�� CITY E/{Ve�.P-Y-i'� (jr)STATE1it- y�/� ZIP R6 zog <br /> OWNER PHONE:id 6j-g42,- ( 10A 1 1 OWNER EMAIL: j-11 VlC'4c gL:l l 1 J. [[[[[[�//////,. <br /> CONTRACTOR NAME: ']line Ft/Ant <br /> CONTRACTOR ADDRESS: STREET 1 116 1-w-t l 1 -- ,..5 J 71 <br /> CITY I'1000+(II to Tti,VI1- (e STATE ZIP6/3 <br /> CONTRACTOR PHONE: l7)_"71 I -1 13�i CONTRACTOR EMAIL: jV-3 61 -N(y7,'e� �am <br /> CONTRACTOR LICENSE#(REQUIRED): `(f e FFI-1�� h CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):/(" 27 qo <br /> PRIMARY CONTACT: 0 OWNER NCONTRACTOR 0 OTHER(Please Specify)(�/� <br /> CONTACT NAME: /� CONTACT PHONE:CI�'l I - j I ) <br /> inn til 1 1 4,P( �( CONTACT EMAIL: iryf kip e4ryi <br /> Existing Use of Building: Contract Price of Work:$ dd O0c <br /> Proposed Use of Building: Heat Source: ❑Gas Alelectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New lackddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> I� and pn1 &C r1c ce cj►� -e (1A-aid [ J- yrp �/f or) . <br /> J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> a `4$04 HAN101 PERIO Ar(00 :1101 ° M `x ` 0 ,PL RI:1,1NO PERMi'f APP'LU00010 � 4 <br /> Type of Project: _New' Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #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 /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping t Boiler Lavatory(Wash Basin) E Drinking Fountain <br /> Water Heater; Refrigeration Shower 0 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 I Sink(Service/Bar/Mop/etc.) Other: <br /> � T SPRINKLER 11SUPPRESSIONNSY-sYE.l l r al <br /> I Number 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 m <br /> loc l law.The granting of a permit only authorizes approved work and no deviations therefrom.DeviationsIust first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.f am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> AI v I JvP E cii,1 1l�r <br /> f 40 - dt <br /> O <br /> r • !zed =ntj re <br /> Date (Revised 11/12/2115) <br /> 1 <br />