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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/PLUMBING i 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)everettepst everettwa gov I www.everettwa.gov/permits <br /> (Blue or'Black lnkOhty Please) 'PROJEG'f�sITglINI:t t11 A`t'10N =" , <br /> PROJECT SITE ADDRESS: 3141 �►�\n: {t yvl t 1 t ( _( <br /> t� PROPERTY TAX#: <br /> LEGAL for new constriction: Short Plat/subdivision <br /> Lot Na` (attach copy of long legal description) <br /> caNTacr irFalRilA► 'icr " <br /> OWNER NAME: !✓ rtth filet <br /> w TENANT NAME If Commercial): <br /> r <br /> OWNER MAILING ADORE S: STREET 3 Q V <br /> 2. <br /> 4--$...ej <br /> OWNER PHONE: ag <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: i !Yl C <br /> CONTRACTOR ADDRESS: STREET II •(} y ^r+OCL <br /> CITY &e ,tz STATE pr ZIP L{a.Z,0 i <br /> CONTRACTOR PHONE: Z'3 Ct 0 0 CONTRACTOR EMAIL' , N', �e <br /> -C p ACfl#i-LIGEPIS {{REQUIRE .C.,-0\4e73„2-:E7,409-5-R-44,..— <br /> . <br /> (}\ s t C1 "_"CITY-Or-EVERETT-BUSINESS-LICENSElt(REQUIREOriet <br /> PRIMARY CONTACT: ❑OWNER LS(CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4.26 25Cf 055D <br /> +` <br /> CONTACT EMAIL:�. In•4S/a e W1. 04.'TE 'CC)YYi <br /> . .`esu11LDJN 1xtitivati_A 41 " tit 4 <I. „•. <br /> Existing Use of Bulldin Contract Price of Work:$ 0 4 i <br /> Proposed Use of Building; <br /> Heat Source: ❑Gas )Electric ❑Other <br /> Building Type: FR-Detached OSFR-Attached ❑Duplex ❑Multi-Family-#of Units: <br /> ype of Project: ONew ❑Addition ❑Remodel ORepair DT.1, °Sin ❑S rinkle� ion DThangl of Use strlal <br /> DESCRIPTION OF WORK: <br /> 9 p ❑Demolition ©khan e Use <br /> mkttil lele)ti- Ftua-17 <br /> ,ASSOCIATED BUILDING PERMIT#Of applicable): <br /> " . MEC ANiGAL:":PERM11-APPLICATION • Vt .c �y 5 <br /> Typo of Project; New '�;UM1Idt�rRllt//�$ F!I:tCItTtCTN <br /> Addn Alteration Repair <br /> #of - Type of Project: New Addn Alteration Repair <br /> pfYtures L/st ofFfxtures #of _f,. #of i <br /> F7x77i�res t o! 4xiur�x_ Llakot Fixtures #of <br /> A/C—Air Handlin Units Pixtures Fixtures ishofFiutures ---. <br /> Heal Pump Toilet <br /> Forced Air Systems Unit`Heater tJ-7- law Prevenler Inside- ) <br /> Gas Piping Bathtub Uflnal <br /> ----------73-1:311j7--- <br /> Lavatory(Wash <br /> Water Heater i2efrlgeration rYBasin) Drinking Fountain <br /> Gas Fireplace Shower Floor Drain <br /> Woad Stove Kitchen Sink&Disposal Grease Trap <br /> Ran Dustin <br /> Clothes D erHotkups Otller; Dishwasher Roof Drains <br /> Ran a}-30d Clothes Washer Medical Gas <br /> ExFraust Fan Water Heater Other: <br /> Sink(Service/Bar/Mo /etc. Other: <br /> `S____ ER'J'SUPPRESSiON SYSTEM <br /> Chemical or Water N). 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,stale,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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> end!comply with the Slate Contractors Law 18.27 RCW and 296.200A WA C. <br /> City of Everett Official Use Only <br /> ..!f�(1 _ to PER ( / <br /> Owb erIAuthorized Age Sinnature �� ( � 1 O_ l/ �/ <br /> Dale (Revised 9/23/2016) l j <br />