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PERMIT APPLICATION <br /> f <br /> ,saWLDING/MECHANICAL i PL.LIIVII3ING I SIGN I SPRINKLERi DEIt/1OLi' fOl <br /> ,�' ,s CITY OF EVERT I'T`PERMIT SERVICES' <br /> y, '',7:.,44./6....7 3200 CEDAR STREET,EVERETT,WA 08201 <br /> (P)425257-88.10 I FAX 425-257-8887 I(E)everetteps@everethva.gov i w+n w.evvrefiwa.govipermits <br /> £'t ei1E.i.g.i4 4. 1 L4.4Asr4 1Fr'.ia l* tl R.If al e*;10«' ra.y,. . _ ., 7.',:-..::::1 <br /> PROJECT SITE ADDRESS z ein x'"•` at 6Sk PROPERTYTA}C#: <br /> tLEGAL for new construction: Short Pietfsuthdivision Lot„No (attach copy of longlegaldescription) <br /> • } 4• ." ed,I T` ° `ih19P®3hs $A7C1I,i jl�[ ' '',`i <br /> -�j5 <br /> OWNER NAME: L ..I <br /> TEIUANT NAME(If CDrnrnercla1)3 i <br /> OWNER MAILING ADDRESS: STREET 2,ii w. i$1 , r <br /> Oil Y STATE e° c ZIP4CMO) <br /> • <br /> • <br /> OWNER PHONE. !OWNER EMAIL: _. ... _ �.:j <br /> CONTRACTOR NAME:RL 2 O__ GP fAC Y 1. <br /> CONTRACTOR ADDRESS: STREET 2.-t Zo PA-<c e.- <br /> on? (=Fara— STATE ly,tA ZIP ell t G <br /> CONTRACTOR PHONE: H-20} '2 '2- ,g((r4. JCONTRACTOR EMAIL: t - . .35 Witt-Jet--C r <br /> il <br /> CONTRACTOR LICENSE#(REQUIRED) I,:S) f3 c r <br /> r CITY OP EVERETT BUSINESS LICENSE#(REQU[REU) j R5jc <br /> .+uw.wu.x.r,..+wN M.w.f�Yr�'�=Yw.!•+se+r+Va.'+a^+v"vhrwwv.... .er �- <br /> PRIMARY CONTACT: 0 OWNER %CONTRACTOR El OTHER.(Please Specify) <br /> CONTACT NAME: (CONTACT PHONE q) 5-01-077 <br /> 24,.. CONTACT EMAIL: v...&0 6,5/r/ a., rn <br /> '; . -iBUII.TNG PERMITAPPLt> A.TION <br /> Existing Use of Building: Contract Price of Work: 340 <br /> -Proposed Use ofuilding: li-ieatSource: VGas ❑Electric DOther <br /> Building Type: I SFR Detached DSFR Attach d ElDuplex ©Mtiitl-Family-#of Units: <br /> ElCommercial ElIndustria! <br /> Type of Project: ElNew ElAdddition ElRernodel EIRepair IJT I. E(Sign LiSprinkler ElDemolition QChange ofUse <br /> • <br /> DESCRIPTION OP WORK: .7 -.-� (N" % 1- t` ° �. ' N � 'f t ,:' <br /> ASSOCIATED BUILDING PERMIT#(if apylioabfe) ' <br /> ' 0� k> �C li�i'if'' 0; , :Td�'0 _ • PL 916 -18R T App , cA' l•,i v <br /> :` —�--------- Type of Project: New Addrr Alteration •Repair <br /> Type of Project:__••New._.. Arida _:..Alteration ,Repair <br /> ##n f #of ' ;#of #of t tSt of Prtrrres <br /> rstofFixtures Fikfuras List List of Fibres Fixtures Fixtures <br /> 'Fixtures <br /> NG-Air Handling Units Heat Pump Toilet I Backflow Preventer(Inside Bldg) <br /> + <br /> Forced Air Systems Unit Heater Bathtub 1 Urinal <br /> Boiler Lavatory(Wash Basin) Drinking Fountain l <br /> Cas rPHeater <br /> Shower Floor Drain • <br /> Wa#`rt-Teeter R�irl«enation '; <br /> Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas FireplaceageDishwasher Roo;Drains <br /> Gas Range Dueting � Medical Gas <br /> Clothes Dryer Hookups Other: • Clothes Washer <br /> Water Heater Other: <br /> Exhaust F <br /> Range Fan ad Sink(Service/BarJMaptetc.) Other: <br /> _ <br /> 4.a Il Il!.N4YO.Ir ill <br /> I Number'of(leads <br /> ICKVOWLE]G NEN /have reviewed this application <br /> confirmu . Work clone pursuant to this permit must comply with <br /> :urrenand atw.The grantingof apermio uthen'zes approved work and no deviations therefrom7eviatons must first be auth ized In wilting from the <br /> 3uitdingOfficial before eingauthorized <br /> under any circumstance./am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> end i comply with the•State Contractors Law CW and 290.200A WAG. City of Everett Official Use Only <br /> Ctd"ts.", /4„..4 '2----1 57-IQ PERM; <br /> 1(1 t02 . <br /> ;in PrjArrth or•fred Agent Signature <br /> Date <br /> . . . (Revised 6/20/2016) � . <br />