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/ <br /> I � BU LDI VECHAN CAL/PLUMBING I SIGN INKILER I DE OLLIIT�•N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 4 t 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 E everetteps@everettwa.gov I www.everettwa.gov/permits <br /> FAX IO p , <br /> (Ff.llsie or Black Ilok Only Please) PROJECT SIITIE INFORMATION <br /> PROJECT SITE ADDRESS: 14 zil R0 C.-Ka—ELL 112. 4-fri PROPERTY TAX#: V 2 )i I ti 2- 0)0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. ttach copy of long legal description) <br /> C*NTACT HI'IF* -M//TI'I©17 <br /> OWNER NAME:.d j q; e4'. I I etiitit C ; a o N TENANT NAME(If Commercial): p4/1.1 <br /> OWNER MAILING ADDRESS: STREET 2z- I 0 !y /-7i „A-1/V_ -A— <br /> CIT' 'tsWfSTATE 1 j /.q'- .. .ZIP 6 s q,; it 1 <br /> OWNER PHONE:. Q .."1 6 0 g1� OWNER EMAIL: 1`i dpi alt L24%t�:19 �1 ' `r�, 'N t) L )711 <br /> CONTRACTOR NAME: , .16 42.L_ 't `t--(''r, N . <br /> CONTRACTOR ADDRESS: STREET'VI 10 r t' 1 A 1,1:;:› ..-4 ilr— <br /> CITY �!' 9,4G. -;"I s STATE �t " '.... ZIP qfr 'i <br /> CONTRACTOR PHONE: `20k'-' 8'9 XM 013 CONTRACTOR EMAIL: -1 6 y ('_('(.tiDyc& L.c • (7)ill • <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINES'dLICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> 'CONTACT NAME: e1 - �. ri A i CONTACT PHONE: °� <br /> 14-4-41t <br /> CONTACT EMAIL: / AC( 1 <br /> BugL®ING PERMIT APPLICATI 14 <br /> Existing Use of Building: ' i,t ,_ L,541 6 ! Contract Price of Work:$ 3 13-� O <br /> Proposed Use of Building: j-In `,c \ t,Viti Heat Source: ❑Gas PhElectric ❑Other <br /> Building Type: OSFR-Detache @SFR Attached ❑Duplex @Multi-Family-#of Units: @Commercial ❑Industrial <br /> Type of Project: ❑New @Addition yiemodel ❑Repair DTI. @Sign ❑Sprinkler ❑Demolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> - c�«L_e, y-at . i 4Duj1 v-co f ; 1o .flJ Olygii&W°li <br /> 47 JC ilir,vc 5 , lit e/ ) U7,' ,)4t f/ t e 6 �U1-i -f , 51ics; ,/r ioi.cto 5 <br /> t <br /> ASSOCIATED BUILDING PERMIT#(if applicable): NL 04:3i l 0 3) <br /> MIECH' VOCAL HEI'MIT A;PLICATION PLUM L.[PIG PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration _,Repair Type of Project: _New Addn _Alteration 9C Repair <br /> #of List of Fixtures #of List of Fixtures #of 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 Unit Heater Bathtub Urinal <br /> Gas Piping Boiler t Lavatory(Wash Basin) Drinking Fountain <br /> ' 1 X, Water Heater Refrigeration ( Shower Floor Drain <br /> Gas Fireplace Wood Stove i Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> ) Clothes Dryer Hookups Other: i Clothes Washer Medical Gas <br /> t -, Range Hood e Other: <br /> I '5e; Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPIRITS i<LC IR/SUPPi?IESSI©IM SYSTEM <br /> Chemical or Water No.of Heads - <br /> ACKNOWLEDGEMENT::l 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296200A WAC. <br /> City of Everett Official Use Only <br /> PERMI �/`� <br /> 1,<Xe : ��, ; " "``. 111ti(A) 1.10 <br /> Owner/Authol d Agent Signature Date (Revised 9/23/2016) <br /> 0 <br />