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PERMIT APPLICATION <br /> 01:77" BUILDING / MECHANICAL/ PLUMBING I SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ti-'1 425-257-8810 I FAX 425-257-8857 I(E)everetteps a@"ieverottwa g€zv I www,everettwa.gov(permits <br /> (Bine csr'Black Ink'Ont 'lease <br /> PRCtJCTfYtiNFCftlfi'[lIOM -rtA ,°.: <br /> PROJECT SITE ADDRESS: '4/ t ,'� <br /> '4%���...ttt��.�..ttt �4�� rl t St PROPERTY TAX#. <br /> LEGAL for new construction: Short Plat/subd',,cc on --- –'a <br /> Lot No. (attach copy of long legal description) <br /> CONTACTiINFORMATION ' # <br /> OWNER NAME: ._.. x' <br /> ... ^� (_Les, TENANT NAME(if Commercial): <br /> OWNER MAILING ADDR'° 5: Y t CAA a' <br /> STREET .yy <br /> CIT' • a r �H '}""j� -..,ry/ ) <br /> a.� t JSTATE i R J Z'n { e F^< <br /> OWNER PHONE; A( J L"1 ' I Q V <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: _ <br /> CONTRACTOR ADDRESS: STREET t 1.4 (orac+.. e <br /> cry ;_ s <br /> STATEZIP 0 I <br /> CONTRACTOR PHONE: 1.-1-2.S Z q <br /> �6Q CONTRACTOR EMAIL•r,t..i 4 `, ' !4.--111,0 .60 <br /> -C9NTR.A;.T4R-610ENsE-#!REoUI??EL79:-Cm 4e7,-, --"t„ <br /> C ` s R 4- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)` 10 foci g <br /> PRIMARY CONTACT: Cl OWNER L"CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L. .2S 25(7 C) 52:) <br /> C <br /> CONTACT EMAIL: leArlj /a °� (�YYL! kept,"}LSA .CD' ' 'l <br /> BUILDIIIG PERNIttAilftICATiO't *• ''`: , > r, : . <br /> Existing Use of Building <br /> Contract Price of Work:$ 5-60 <br /> Proposed Use of Bgilding: --- <br /> Heat Source: ❑Gas lectric ®Other <br /> LBulitiin Type.: <br /> . ) R�Deta�cAddifion�S�Remodel d D�D�f plea 0tV141itf Famif -t�of Units: ❑Commercial ❑Industrial <br /> t' SF <br /> pe of Project: ❑N <br /> DESCRIPTION OF WORK: eoair DTI. DSI n 05pfinkle, ❑Demolition 0Cttpngt�of Use <br /> V15--a'v vim p <br /> ASSOCIATED BUILDING PERMIT#ofable): . b <br /> lVIEGNANICAL:PERMIT APPLICATION , _: " ' fit, <br /> Type of Protect: New ,P'LU t: 3�"RAddn Ai,PL 1 ratio ION <br /> Addn _Alteration _Repair <br /> #of Type of Project: New _Addn Alteration Repair <br /> f txmrrrs �1f Ftxfurs _. #of #of <br /> FiX_tures —Usd of Fixtures dist-of Fixtures ...— .__#of <br /> AIC'Air Handling Units Fixittros Fixtures L f'nf Flrtures-- <br /> Forced Air Systems Heat Pump Toilet <br /> Unit Heater Backflow Preventer Inside Bid() <br /> Gas Piping Bathtub Urinal <br /> Water Heater Boiler Lavatory <br /> Y(Wash Basin) Drinking Fountain <br /> GasFire�piacehawer Floor Drain <br /> Gas Fan l Wood Stove Kitchen Sink&Dis:osal <br /> E�uctir.} Grease Ira <br /> Ciathes Dryer Hookups Other: Dishwasher <br /> Ran a Hood <br /> Clothes Washer Roof Drains <br /> Exhaust Fan <br /> Water Heater Medical Gas <br /> Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> P$UUNKLERTSUPPRESStON SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this app/!cation end confirm the Information contained herein Is(rue end 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18,27 ROW and 296.200A WAG. <br /> City <br /> \of Everett Official Use Only <br /> es, <br /> PERMIT# <br /> .s,. .,,,+_,t <br /> (_Q rn yyy��� <br /> � <br /> Ow,w,ar/Authorized Age Signature <br /> iti/v �J <br /> ^ Date <br /> (Revised W23120 6) - _ <br />