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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> P 425 257-8810 FAX 425 257-8857 E everette,s everetfwa. ov Www.everettwa. ov/ermits <br /> ( } f f{ } pts g I , g p • <br /> ( he-or Buck ink pRufPROJECT SITE iNFORMATIOi <br /> PROJECT SITE ADDRESS: /tl 1 z56"---- 'g j 'w" PROPERTY TAX A' <br /> LEGAL for new construction: Short Piat/subdivlsion Lot No. (attach copy of long legal description) <br /> CONTAGY.IIMFORiVMATION ' ' <br /> OWNER NAME: A,14,) Lil (,. ,L TENANT NAME(If Commercial):. <br /> OWNER MAILING ADDRESS: t—r suiion —I '['ni.,e 68" <br /> J .,� <br /> cny GVH?'_-t STATE ZIP y 223 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: E V ,1J 6ire 02 <br /> CONTRACTOR ADDRESS: STREET '2-I?X, fel - At)V <br /> coy Uelezi t- STATE [it,A— Zip /41214( <br /> CONTRACTOR PHONE: s5:2. CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(R> QUIRED) Eli 4S 02. 1- CITY()EVERETT BUSINESS LICENSE tr(REQUIRE7) 0. 6" ,5 <br /> PRIMARY CONTACT: 0 OWNER 1 1,CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 7 5.. j 2°'`:r/f <br /> Kea) CONTACT EMAIL: <br /> bi:11 161 "PERItIl1 a'AAPLIcAT1014 - <br /> Existing Use of Building: Contract Price of Work:$._ V7171/11111141111111111111111111111111° <br /> Proposed Use of Building: Heat Source: ►- as DElectric ElOther <br /> Building T pe: OSFR-Detached DSFR-Attached QDup!ex OMultl-Family-#of Units: litCommercial Dlndustrial <br /> Type of Project: £New DAdditlon ClRemodel ©Repair O71. ❑Sign £Sprinkler £Demolition HChange of Use <br /> DESCRIPTION OF WORK: etit' '"t i - L(i i t+cc '€ c <br /> w 14411, , tS Gcu vi.ects_rctz <br /> ASSOCIATED BUILDING PERMIT#(if apalicable):_- <br /> APPLICATION ! . • • , PLUIVIEING l ERMiT APPLICATION • <br /> Type of Project: New Addn Alteration_,Repair Type of Project:_New Addn Alteration Repair <br /> #cf List of Fixtures #of List of Fixtures #°f List of t7xtures #°f List of Fixtures <br /> rixtur•s Fixtures FixturesF/xtures <br /> mug AFC—Air Handling Units Hest Pump Toilet <br /> Backflow Preventer(Inside Bidg) <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(ServlcelBarlNlopietc.), Other: <br /> S.UPI RESSIOH SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:Maya reviewed this application and confirm the informationcontained 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 underanycircumstance I am the owne,or am authorized by the owner of this property to perform the work forwhich application Is made, <br /> and/comply with the State Contractors Law 18.27 RCM(and 296.200A WAG. <br /> City of Everett'Officialmi6pUse Only <br /> FERMI o -0 <br /> Owner/Aixed Agent Signature Date (Revised 5/20/201 <br />