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• <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION - <br /> 3—/1145/7 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 I eww.everettwa.gov/permits <br /> (1.4664:4:.®r bletat 1nitc®.nly tease) ' . 'R®JJEGTi'�kI I[JFO MAIrlfO1 .. <br /> PROJECT SITE ADDRESS: IS/ PROPERTY TAX#: /)057 Z 0,010,09.7-0/ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ ..CONTACT`I IP®RMATI®R9 . •. . . • • • • • • • • <br /> OWNER NAME: /5[E.)7Z-- t l tle 2. • /id TENANT NAME(If Commercial): 4a S g-05,3 , <br /> OWNER MAILING ADDRESS: STREET I q�`' /-3,44,21" co /� Q �n • <br /> CITY WV� STATE W/`r' ZIP `(3(�v , <br /> OWNER^PHONE '..,,_„m .,,..,� , . <br /> .r. __ .,,.,,,.. ........... .....,,,..,-. DOWNER EMAIL:, <br /> CONTRACTOR NAME: E UeK.6MA.) 6t/A-Te: e' bt2T <br /> CONTRACTOR ADDRESS: STREET 212-0 fArcA Acl cr <br /> CITY 0 VW-MT T STATE A 4– zip p elgo <br /> CONTRACTOR PHONE: 4-2,5,2-5 2-'5!« <br /> • CONTRACTOR EMAIL: Ij/14 & /tla.)11 k Olt' <br /> CONTRACTOR LICENSE#(REQUIRED): COGIt2.y S 4922.0 L" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CI 6-7 ey,5- <br /> PRIMARY CONTACT: 0 OWNER JaCONTRACTOR 0 OTHER(Please Specify) - <br /> CONTACT NAME: 4 CONTACT PHONE: 47'caX5-2.°.. //fI <br /> ,vi rAli , — CONTACT EMAIL: /4464 "( <br /> - • <br /> lee- <br /> ) IJIlLDJNG I itlll'� l�+l!(�AION - • :• <br /> Existing Use of Building: � ! ContractPriceof Work:$ � ®Use of Buildin : G'/{4,4 Heat Source: ❑Gas Electric ClOfher <br /> Proposedg <br /> Building Type: ❑SFR-Detached CISFR-Attached ❑Duplex EIMulti Family#�of Units: ®Commercial Cllndusfriaf <br /> Type of Project: ❑New DAddition QRemodel [ Repair 01".1. ❑Sign ESprinkler ElDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: 4,../5 , ` •7'f ^J76c ¢Gr f /ti'7 <br /> tie i/ <br /> 570A) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ' .MEC ,MICA!PMRIi([IT'APPILICAT IOM I I . • . 1PL UMVII ING 0Blk61MIT APPL,ICATI®H • <br /> Type of Project: _New Addn Alteration J_Repair Type of Project: New Addn Alteration __Repair <br /> f4 of <br /> Fixtur#oes List of Fixtures I Fixtures List of Fixtures Fixtures List of Fixtures Fixtur s List of Fixtures <br /> A/C-Air Handling Units Heat Pump i 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 /> ,IFRif 191KLEkj 41PFR-Ep d 9 SYSTJ IVI . , <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,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> CVN--00 30//9 ' (4103— C7i. <br /> a /Authorized Agen ignature Datb (Revised 5/20/2016) . <br />