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PERMIT APPLICATION <br /> "(PS,Z---_ .-.i: BUILDING I MECHANICAL/PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> r 2:7- <br /> T <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 /> g9pq�rq g gp�g g gg}___,�.� <br /> _t -M - _f,.$iRft6ag C *Wit �i31FHffA ABY.®ARIM <br /> P T E R <br /> AD,C 1 5F�2, PROPERTY TAX#: <br /> LEGAL fornewconstruction:� Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> StattaingentORNONMENOMM:07.04007.4a651011MMOUNIMMEMPECOMMORKON <br /> OWNER NAME C1,if--7776,/0(914 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: , STREET -3Q0-3---3Q0-3--/8 Sl-- <br /> p <br /> c"61 c,6 STATE�1l/1 ZIP <br /> OWNER PHONE:4-A.Q'S 7S`%/7c OWNER EMAIL: <br /> CONTRACTOR NAME:1/J.�s�:� C, i t?i' ''c, LC— <br /> CONTRACTOR ADDRESS: STREET / / n <br /> pc,( . i gS t cnr 3c ( '& sTArj.. ziP Pi?7 i^ <br /> CONTRACTOR PHONE: j 794! c"3 3'F" CONTRACTOR EMAIL f esfet a 4445/ -AfOt)I I <br /> CONTRACTOR LICENSE#(REQUIRED)G4k>to. -„erLel`t,R'z) i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED 90 <br /> PRIMARY CONTACT: `OWNER 0 CONTRACTOR 0 OTHER(Please Specify) 'SS.9 j' <br /> CONTACT NAME: CONTACT PHONE:ios-...'3 s9-S- 30 I <br /> , ►c-el CONTACT EMAIL: <br /> ®p�■f ■®gyp }g ®pp■q! /��g®:*.�-g_yyaay.�w!��_.gg, y'�i <br /> .ri- �� .4� r .i- ,7 �° ...v._..r.'.. 5....._. ,E,lylllLll)i NO.,i"aRtklt.�.irgirTL.i FB 'R;,®®8_®."�':Li4.'S.: .r.. } J!4 h 2, 3 <br /> Existing Use of Building: Contract Price of Work I 30 c. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project ❑New ©Addition ORemodel ORepair 0T.1. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ., __ ; MEetai' etti jVati FPLtCA AN __ ,,' _•. I'LUIV1C1NG1PERMlt_(0.02 ATION Ll = z <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> i! <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—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 i <br /> l <br /> Water Heater Refrigeration . Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> E <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas 5 <br /> Range Hood >( ..gWater Heater Other: li <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: j <br /> h _--_- ' "M1CLY% .lPiatdESS.AON eaTiVt^=1-z'- z <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 1 <br /> Building Official before being authorized under any circumstance.lam the owner,or l am authorized by the owner of this property to perform the work for which application is made, 1 <br /> and I comply wit. e Sta ant,:ctors Law 18.27 RCW and 296.200A WAG 1 <br /> / City of Everett Official Use Only I <br /> F: <br /> ,/ PE T#t n 0.2j4 <br /> 5 <br /> •wner/Author ed A.,ent Signature ate (Revised 10/12/2015) i <br /> I <br /> i <br />