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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING 1 SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@evereltwa.gov i www.everettwa.govtpermits <br /> 1.0* 4.....- !!*7.:',.1.1 , �:•t _fi A <br /> PROJECT SITE ADDRESS: 1502. a. PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> ''--713 '1,..,..i4..: 61 x::1.4 A N`S _. b 1 ? <br /> OWNER NAME: r "i „ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETpy;try,/314V.e. <br /> crrY YAM. <br /> STATE zo 304.E}� <br /> S7 <br /> OWNER PHONE: � OWNER EMAIL. , - , a <br /> CONTRACTOR NAME: Da co vi 54-tet/S(4-1' • d IllC, <br /> CONTRACTOR ADDRESS: STREET 54 35 skilopt 4 zao <br /> { <br /> CITY P(1!7 STATE 4. # <br /> ` <br /> CONTRACTOR PHONE: , •F r CONTRACTOR EMAIL: ; ,4dJ i a <br /> CONTRACTOR LICENSE#(REQUIRED): »T" #,r OCC V11 CITY OF EVERETT BUSINESS LICENSE#(REQUfREO: t,s,y: ",a rtk. i <br /> PRIMARY CONTACT 0 OWNER El CONTRACTOR D OTHER(Please Specify)„ R' t t <br /> CONTACT NAME: CONTACT PHONE: 4 c?ih. - ' < <br /> lir I CONTACT EMAIL: <br /> rx., ...• !'- UI., 1NG P nI.ieA:Tt' k £. ,".. , <br /> Existing Use of Building: r2az,i_0 Contract Price of Work: /ISO. °• <br /> Proposed Use of Building: 'Heat Source: OGas ■Electric DOthe <br /> BuildingT e: ©SFR-Detached 1:SFR-Attached ODu iex DMulti-Family-#of Units: ` m <br /> Dlndy&trial <br /> dType of Project: ©New DAddition ©Remodel DRepar MT.I. OSign DSprinkler emolitionDChange <br /> of Use_,. <br /> DESCRIPTION OF WORK: ,+ f t:VliA,5keoSj 4e11110,‘ 6.10.(iii C. <br /> De„,18Aertit:01,N. &WI tkOrt01," <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> P'1' MECAL.ip',..RHMT APP .IfATIONE ,. 4'g `i" I D.- ., I,I R'1tMT !PLi rfolg- g._s gg,gE s4,W <br /> Type of Project: _New Addn _Alteration Repair Type of Project: Now Addn Alteration Repair <br /> of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> `AIC—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 Draind <br /> Gas Fireplace Wood Stove Kitchen Sink&DisRosatGrease Trap <br /> Gas Range Ducting .Dishwasher .Roof Drains <br /> Clothes Dyer Hookups Other: Clothes Washer Medical Gas <br /> RangeHood Water Heater Other: <br /> Exhaust t Fan Sink(Service/BariMop/etc.) Other: <br /> .,. <br /> Chemical or Water 1 <br /> No.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 be' , uthorized under any circumstance,tam the owner,or I em authorized by the owner of this poperfyto perform the work for which application is made, <br /> and I comply with the -' • ►.ntrectors Law _'.27 GW and 296200A WAC, <br /> City of Everett Official Use Only <br /> " � PER MITt . / �i 1 <br /> Owner!, thorized Agent Sign Date (Revised 9/23/2016). <br /> I' 1 <br />