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PERMIT APPLICATiON <br /> :044/ :—/-1 BUILDING I MECHANICAL I PLUMBING I SIGN i SPRINKLER i DEMOLITION • <br /> T CITYOF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ' (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov f ysnw✓,everettwa.gov/permlfs <br /> (i»i3'41:;r ble k hlk o ie se ' = ' I/E67'' ut't IMO,' IwAAY IO , . , <br /> PROJECT SITE ADDRESS: / 5 J F fl i!P _PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long regal description) <br /> OWNER NAME: / .tit 4 e TENANT NAME(If Commercial): <br /> OWNER MAiLiNG ADDRESS: STREET 57 , , _ A vE <br /> ZIP ( <br /> I car -'� �/7 rr STATE_' /AM ,_ v o V / <br /> OWNER PHONE: 47‘25" ZJ ( (y-2_ OWNER EMAIL: <br /> CONTRACTOR NAME: 4 U z.G I\J 6`&TI'-T( tLECer.Pt 61-4-e_ <br /> CONTRACTOR ADDRESS: STREET °2-12.4)f ) r/ 4l A()er , <br /> in * V WASIT STATS (A.✓4-- ZJR i C3' <br /> CONTRACTOR PHONE: 4#25,°-52.-13/I CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): f (,y jg®2,2.0 r CiTY OF EVERETT BUSINESS LICENSE#(REQUIRED): F.16 r -T. <br /> PRIMARY CONTACT: Q OWNER ONTRAC T OR 0 OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT P'IONE: 4 7 5"...2-5'2 d` f/ <br /> CONTACT EMAIL: <br /> • .• 11L1iPkt [T APP,LCATXO " •C• • • <br /> Contract Price of Work: ' , r• <br /> Existing Use of Building: $ �, w/ - <br /> Proposed Use of B ilding: Heat Source: DI Gas EIEfecfrfc ElOther <br /> Building Type; Detached COSFR-Attached CUDuplex ,ElMultt-Family-#of Units: E(Commerclal Efindusfrfal <br /> Type of Project: DNew CiAdditIon EIRemodel ❑Repair g%, DSIgn l7Sprinkler EiDemolition E1Change of Use <br /> DESCRIPTION OF WORK: <br /> AA/0 fi© c�Yi5Tik/ 445 Fw ,� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :• ' ••IVf'eCHAN1(C.A[;Pl Rn/i1T APPLtCATlOki1 I ( 1�1r��9it1I�IC�C�RERf IP f� (�ifC IO <br /> Type of Project: _New Addn Alteration _Repair I Type of Project: _New ^Addn Alteration _Repair <br /> °f Lis <br /> t <br /> Fixtures of Fixtures #of List of Fixtures ! #°f List of Fixtures i #of <br /> Fixtures List of Fixtures Fixtures Fixtures <br /> t A/C—Air Handling Units Heat Pump I Toilet al=Backflow Proven-ter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller ! } Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower • Flocr Drain <br /> Gas Fireplace Wood Stove um Kitchen Sink&Dls.osa( Grease Trap <br /> Gas Range Ducting ,Dishwasher Roof Drains , <br /> Clothes Dryer Hookups Clothes WasherMedical Gas <br /> Range Hood Water Heater :Other: <br /> Exhaust Fan Sink Service/Bar/Mop/etc.) Other:_ <br /> .'sItiliN YKLEi I.BJPP� p.mi.t9 SYSTEIviif _ lail <br /> Number of Heads _ =___ — <br /> 1KNOWLEDGEMENT.'I have reviewed this application and confInn the Information contained herein is true and correct.Work cone pursuant to this permit must comply with <br /> rent 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 /> *ling Official before being authorized under any circumstance,lam the ownet or am authorized by the owner ofthls property to perform the work for which application Is made, <br /> f/comply with the State Contractors LaW/8,2TRCW and 296.200A WAC. <br /> City of Everett,Yflciai Use Only <br /> PER ! # <br /> 1 \41tD )---b(1. <br /> ler/Author zed Agent fare Date (Revised 5/20/2018) . <br />