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PERMIT APPLICATION <br /> BUILDING!MECHANICAL I PLUMBING/SiGN/SPRINKLER/DEMOLITION • <br /> cif YOF 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 I www.everettwa.gov/permits . <br /> (bitis•®r black in{.4.i iiii7C.P1® s3) • : . PROJEOT.tieft INFO,KIWATICIA • .. • <br /> PROJECT SiTE ADDRESS: / ? 2_9 /or i♦/i PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .coNtAd5r,i 'fi'Oit3bWAT(1®&yl . . . • . . . • .. • . . .• <br /> OWNER NAME: /li�I€ MI- /�t4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 217 i ( t( / .(J(TT- l • <br /> lr�f�J <br /> Lp��-( 6�CITY lt/812-0V- <br /> JJ Z4 STATE Elt ZIP Q�j'!/✓I <br /> OWNER PHONE". ''...,J.. lv— l'Zv "[ r.,...,... ..,-m OWNER EMAIL:,. . .w........ ..,,.... ..T,....,., ,,,,,..- ,.... �_.. .. <br /> CONTRACTOR NAME: C1JCK.CMil,„) 6TttTT( ffECr I-c- <br /> CONTRACTOR ADDRESS: STREET `2-1'2,0 PAC-1 Fit. ikc)a" • <br /> �j p� <br /> CITY ' U 2 { `~ STATE LAI A— ZIP p C7`°r <br /> CONTRACTOR PHONE: 425.-2.52.o3//( - 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): EVC42.6,4S X2,24 T CITY OF EVERETT B USINESS LICENSE~#(REQUIRED): $15 61 'M1• <br /> PRIMARY CONTACT: 0 OWNER KCONTRACTOR El OTHER(Please Specify) • <br /> CONTACT NAME: i iCONTACT PHONE: 4 7 5 2-5'2 d')//V <br /> �,(-, L— <br /> i) CONTACT EMAIL: /,„e M Cv_e "5n44, •, 6a eu— <br /> . : • . .. ,. laIJIiDIN(3 P tiiVTri'APPLfdA°)i`I(®rer• • . • . • . -•-: . . <br /> Existing Use of Building: I Contract Price of Work:$� ggq. fi� <br /> Proposed Use ofBuilding: Heat Source: 7 Gas ❑Electric ❑Other <br /> PT <br /> Building Type: OSFR-Detached OSFR-Attached C(Duplex ElMultl Family of Unifs: Commercial Cllndustrlal <br /> Type of Project: IJNew EIAdditton ❑Remodel DRepair 07.1. DSIgn ❑Sprinkler ❑Demolition ElChange of Use <br /> DESCRIPTION OF WORK: �(yx,. (, L; vox_ onatua. w�Uuti°T 't (- t(Vet6, (16-cfT—. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> •: • . liteG�,AN1Cti.Otittll1T APPL1C;�`iCYCt� _. P�uN!>BI Ca Pt2i�t1f11T A>t PffJ1'I <br /> C� C <br /> Type of Project: New Adds Alteration_,Repair 1 Type of Project: ,New _Adorn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures I #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures . <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <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/Mop/etc.) Other: <br /> :.EFiXi! 9(LEN/ ill PROSli®NY SYSTEM ' ' I <br /> (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 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,ori em authorized by the owner of this property to perform the work for which application/s made, <br /> and I comply with the State Contractors Law 18 and 296.200A WAG. <br /> City of Everett Official Use Only <br /> 4 J (1 PER I v"yo.0 1...._ <br /> ©-Jl <br /> )caner/Authorized gent Signature Date (Revised /2012010) <br />