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PERMIT APPLICATION <br /> BUILDING i MECHANICAL/PLUMBING I SIGN I SPRINKLER I DEMOLITION • <br /> 04/7CITY OF 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 1 www.everettwa.govipermits <br /> (6[4ee'or stack Ink®.niy.Please) • : • PROJ :•1-,:;'.-t►NFO• YVTA` `gON • • • <br /> PROJECT SITE ADDRESS: (IUD IIP• Wt i A-c6 ittiuPROPERTY TAX#: ,a(OS 002.I5-I bo <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of tong legal description) <br /> CONTACT IINFORMATU N • •• . . •• • _ <br /> OWNER NAME: b c ' 4T!L VC 01 e4kC.tv TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (((C> RAI 01 071-- . e • <br /> CITY 0aYN1T, W q <br /> ' A` I a 104 STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> .... <br /> .. <br /> .. _ <br /> CONTRACTOR NAME:...EU _' A�........6Tr -"(C n_ �af(Cer A' 1A-c .,,:. .. . ,. ,... ........ .,,,.,__. ... .,..,. ._...., <br /> CONTRACTOR ADDRESS: STREET °2-i SO [ 1 AU gr <br /> i.CITY U PIA"- <br /> (A)4-- ZIP 6/272o( <br /> CONTRACTOR PHONE: 4�-5>° e;2_PFJ« CONTRACTOR EMAiL: M*ar ' @ 4.0wt4• . c..--, <br /> CONTRACTOR LICENSE#(REQUIRED): E(,�5 a.S d>2,2„.0'1'' !CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (2 o1, ,s-5- I• <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NA : CONTACT PHONE: 475...j 2.d->//9 <br /> m, CONTACT EMAIL: I_ ;i k @ C�j*l e.A .Lk,... . <br /> Existing Use of Building: D 'cGe 1 Contract Price of Work:$ ,,000 <br /> Proposed Use of Building: QF4c L Heat Source: tidGas ❑Electric ❑Other <br /> Building Type: ❑SFR Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: '1Commercial ❑industrial <br /> Type of Project: ONew ❑Addition ❑Remodel [ Repair ❑T.I. ❑Sign OSprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: RDowc.. Z•ati(cr.-�6 -3)c 310/4.6d Ih 141744-'i 145-1 t.) (-110 • 5/$A-e I o�w--Cte-00, 5/3t. . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> : .IViE-CIRAikl!CAL PERIi/II' OPILWA u g® '1 I . • • . PLI ii#61rfe PEIRItil1T APPLgCATIO • <br /> Type of Project: New Addn _AIteration )6 Repair � j Type of Project: ___•New Addn Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures i Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units : g- 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 R• efrigeration Shower - Floor Drain <br /> Gas Fireplace _ Wood Stove Kitchen Sink&Disposal ' Grease Trap <br /> Gas Range Ducting , f 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 /> ' . : :.afi.ROiLE 1 01J1PPtiEPP1(0.9 SyyTIEM I <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.1 am the owner,or!am authorized by the owner of this property to perform the work for which application Is made, <br /> and/comply with the State Contractors Law 18.27RCW and 296:200A WAC. <br /> City of Everett Official Use Only <br /> PE 17# <br /> a 5/3/17 <br /> I <br /> Pa <br /> �C310S `' a- <br /> )caner/Authonz Agg <br /> ed Signature Date (Revised 5/20/2018) <br /> • IZ <br />