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• <br /> 04reffiT. PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER/DEMOLITION - <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> MN-6'6i Black Ir*®.n(y-Ptease•) ' SROJE6T--M.=t INFOD8J1ATIOIN • • <br /> PROJECT SITE ADDRESS: (lilt? Wt NI.AVA06 V10.4) t+t— V k_ '[PROPERTY TAX#: 2/4-pst 8c>Q wocro <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) <br /> _ • ..COEattA65`.IidlrOkAfilATI®N • . . <br /> OWNER NAME: `C `~1 i I jJ 'L TENANT NAME(If Co (mmercial): <br /> OWNER MAILING ADDRESS: STREET (Zi 6 W s MAW 06 Vtbz,c.) ID it_ t Qp� . <br /> CITY V.U{A _I STATE W ZIP Gp 2-7Z <br /> OWNER PHONE: OWNER EMAIL: <br /> ^ <br /> ...,........ ,. ... .,.......,....... . . . ..,. . . .. .. .. <br /> CONTRACTOR NAME: EU�1n �c 6�aryiR - <br /> CONTRACTOR ADDRESS: STREET S-1 /2) 64C-1 Au . <br /> CITY S()M ` STATE ty 4_ ZIP 1 S�� <br /> CONTRACTOR PHONE: 4`2,5-2.•52.P`5i Kt • CONTRACTOR EMAIL: f4/9.6 -Q 5S 'j,+"av4 .6"4, <br /> CONTRACTOR LICENSE#(REQUIRED): Er OSP-66 S <br /> t 2 jS c>2-20{` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): • e i q 5-5- • <br /> PRIMARY CONTACT: 0 OWNER 1aCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM CONTACT PHONE: 4 7 5-252 tl`�i/9 <br /> ivithat ftfrie CONTACT EMAIL: MA-kit @ C.SS 14 7 , <br /> .-0.• 2 . <br /> .' .- ' . ' . BUILDIING•PERMIT APP,>LICA`i7ON ,,//' - - . •. . . : - <br /> Existing Use of Building: !' t <br /> Contract Price of Work:$ '7..6 0 a <br /> Proposed Use of Building: Ho c., Heat Source: Inas DElectric Other <br /> p <br /> Building Type: ❑SFR-Detached ❑SFR-Attached DDuplex ❑Mufti Family of Units: E ommercial ❑lndusfrial <br /> Type of Project: ❑New CDAddition ❑Remodel P1 Zepair ❑T.I. ❑Sign ❑Spriinkler ❑Demolition CDChange of Use <br /> DESCRIPTION OF WORK: OADU 1- n_n(Q,1-3c (ALS Co-4. Lac-iv 1 t Z(cam 10 LV Aru S. ui0D 4-• •rc. <br /> • <br /> S LS +a IP e-tp,e tkai-,t T-)1-14-1-5.. *go aloilztzZ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 11 <br /> - OI:AWCAb•0EItMuT APPLIC ;TI®kl I 1 . • . PLUIVWING liE lifilr APPLiCATI®0 <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures #of 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 <br /> Gas Piping <br /> Unit Heater Bathtub Urinal <br /> Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower <br /> Kitchen Sink&Disposal <br /> Floor Drain <br /> Gas Fireplace Wood StoveGrease 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 /> .SPRWNXLE I S,U1OPR; SSION SYSTEM ' <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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �,i '` <br /> City of Everett Official Use Only <br /> C �� �-l.% �/ PERM ssO9 `--0S0 <br /> alp �r 0 <br /> Owner/Authorize ent Signature Date (Revised 5/20/2015) <br /> ri-li,7 <br />