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<br /> PERMIT APPLICATiON
<br /> BUILDING i MECHANICAL/PLUMBING I SIGN I SPRINKLER/q 1,I1CIOt't •
<br /> �' CITY OF EVERETT PERMIT SERVICES 1`' ;
<br /> Negiri
<br /> 3200 CEDAR STREET,EVERETT,
<br /> WA 98201 `''. ,
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetfeps@everetfwa.gov j wwtw.everettwa.gov/permits . .
<br /> (b ua.®r isfaa,c irk ofij3K Year©) ' : • Pilsit:JE6T-Sift J WO.RIVUNTKOIR a`-..
<br /> PROJECT SiTE ADDRESS: 31‘ t - Call li PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description)
<br /> • . ..COMM:iNF®tI4VII TI!AM . . . • • • • • • . . .
<br /> OWNER NAME: S-k-0 r DAL ge-AJ tablVtr-E.5-TENANT NAME(if Commercial): i, /}fit L�LZ J i j ,43 ,1 •
<br /> OWNER MAILING ADDRESS: spier PC), 1I •
<br /> ' CITY e b STATE < < ZIP �y G..� •
<br /> OWNER PHONE:(4(7.4-12-5.-Z _ ©V )OWNER EMAIL: 4'/s
<br /> �.—�-..�,..R........ ... ��!n� ".__�._ ...,..R.�„-,,.�.^4n. �.., .,,..U•ut• . ,.,,pa•..�,,.. .„. ..,.r„n,.u..y.-. ,.. .. ,..F , .,.ac.. ..N ,
<br /> CONTRACTOR NAME; E VI�Ye.� �,I/� 6 roircr f(c'er 026-1'4-
<br /> CONTRACTOR ADDRESS: smear '2-1'2,0 eRc.-1 PC. fit)gr �
<br /> cm, �i V Ki STATE �J,3_ ZIP i o�72.0(.
<br /> CONTRACTOR PHONE: 4`2-5-2-c2.-31 i4 . !CONTRACTOR EMAIL: We-`1-(4)/2 xSi'i Ccx:L.,0 01.4-A.....
<br /> CONTRACTOR LICENSE#(REQUIRED): EL7 I� � v CI
<br /> �S 2.2 °i- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 - -.
<br /> PRIMARY CONTACT: El OWNER �KCONTRACTOR [f OTHER(Please Specify) ,M I N1 •
<br /> CONTACT NAME: i , CONTACT PHONE: 4 7 5--2.5"2.,//(I
<br /> Kt-7%7u CONTACT EMAIL: f6't c�..e,„5 -4.1 kilt_. G`ci`r-t
<br /> . : '1.• •• Oi1L Atte P Rtlnt'T, PR,LC©A1i11ON ' • , . . . .
<br /> Existing Use of Building: t
<br /> of $ 't SCJ.
<br /> Heat Source:
<br /> Proposed Use of Building: ❑Gas IElecfrtc [(Other
<br /> Building Type: ©SFR Detached °SFR Attached [(Duplex Elm
<br /> ultf FamilyContractPrice of Units:Work: l C'ommerciai °lndusfrlal
<br /> Type of Project: [(New °Addition [(Remodel [(Repair 01.1. °Sign [(Sprinkler [(Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: r„..,,,,,„_, ()l c�t 1,s l-4E --- ,�t,(-,�r, /<21-44-- j�
<br /> u \,�r�e,� V la�.L c 1- ems)rel
<br /> ASSOCiATEDBUILDINGPERMIT# ifa..11cable):
<br /> :IVIEcS A.N(CAL.PERIi ITAPPPLKCATK®v . • • • . PuM61me 1iERIVIIT A PPiiJC.ATIO0 :
<br /> Type of Project: New Addn Alteration__._Repair 1 Type of Project: New Addn Alteration Repair
<br /> #of List of Fixtures #of List of Fixtures
<br /> A/C-Air Handling Units I Heat Pump
<br /> #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> Toilet Backflow Preventer(Inside Bidg)
<br /> Forced Air Systems
<br /> Gas Piping
<br /> Unit Heater
<br /> Bathtub Urinal
<br /> Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Hood
<br /> Other: Clothes Washer Medical Gas
<br /> RangeWater Heater
<br /> Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> . 1Ei I YXLER i U.151Pf•ESSIO I SYSTEM
<br /> -— -
<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.I am the owner,ori em authorized by the owner of this property to perform the work for which application Is made,
<br /> and i comply with the State Contractors Law 18.27R. and 296.200A WAC
<br /> Cltiy of Everett Official Use Onlyj
<br /> - l-/,..9',/7 PERMIT l��' `� '� I
<br /> )caner/Authorized gent Signature Date (Revised 6/20/2096)
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