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PERMIT APPLICATION <br /> EUILDING/MECHANICAL/PLUMBING i SIGN/SPRINKLER I DEMOLITION <br /> CITY 01 V TT PERMiT SERVICES <br /> 3299 CEDAR STREET,VERkii,WA 9 201 <br /> (P)423. 07.4010 I FAX 420=2074007 l(E)§verettepsSeverottwa.gov I www evorettwi-@ov/perrnits <br /> (Blue or Biack Ink'Only Please) PROJECT SITE INFORMATION .. _ <br /> PROJECT SiTE ADDRESS; 214 77th Place SW PROPERTY TAX A; 00389600001300 <br /> LEGAL for now construetian; Shod filet!§���ivi ieP ___Lot No, __ (attach snpy of long legal doscriptien) <br /> CONTACT INFORMATION <br /> OWNER NAME; Mark and Sharon Hayden TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: ate€€f 214 77th Piave SW <br /> WV Everett 617Washington i3 98203 <br /> OWNER PHONE: 253-651-9596 OWNER EMAIL; mhayden43@msn.com <br /> CONTRACTOR NAME; �I <br /> CONTRACTOR ADDRESS; aTP€€fi <br /> Ciry aTATe ZIP <br /> CONTRACTOR PHONE; CONTRACTOR EMAIL; <br /> CONTRACTOR LICENSE P(RLQUiRED); CITY OF @v@IETT dill@!NESS LICENSE ff(R€QUIREP); <br /> PRIMARY CONTACT; OWNER ®CONTRACTOR ei OTHER(Please Specify)_.._� <br /> CONTACT NAME; CONTACT RHONE;253-651-9596 <br /> Mark Hayden CONTACT EMAIL; mha den43@msn.00m <br /> BUILDING PERMIT APPLICATION A. <br /> Existing Use of Building; Contract Price of We-4.41:115., a a- o O v <br /> Proposed Use of Building; Hoot Source; ClOas `Electric ®Other <br /> Building Typo; EISFR=Detached OSFR=Attached CiDupleK CiMulti=Pamily#of Units; OCommerciai ®industrial <br /> Type of Project; New liAddition ®Remodel ORepair DTA: ®Sign aSprinkler ®Demolition Change of Use <br /> DESCRIPTION OF WORK; <br /> lo cW`eGi 7�0 �vcr ly ra d <br /> ASSOCIATED BUILDING PERMIT#(if applicable); <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Proj@ot —Novy Addn =Alteration Repair <br /> rffigi Lift of Wow Lig of€otrrt § of <br /> iia€of Fixturff Lig of Fiarterea <br /> 11111111111reirrarmai mans Heat Puma Toilet Backflow Preventer(Inside Bldg) <br /> '[: _`_..111ht b -_ Urinal <br /> Cas 'roin =oi or Lavatory(Wash Basin) Drinking Fountain <br /> aTIC=NEMENI e aeration Shower :Mloor Drain <br /> M 1 ) _ Kitchen Sink A Disposal ` ,Grease rap <br /> @as :ante M uctin_ dishwasherRoof Drains <br /> R isramnrgri.' E2231011111111111 Clothes Washer Modica!Cas <br /> MOM Ramie Hoe= Water neater Other; <br /> Exhaust.anin; ervice/Bar/Mo etc: Other; <br /> _._..__ _.. <br /> Chomioal of Water No-of Heads <br /> ACKNQWlSB(SMSNT i have reviewed this applioatign and confirm the information contained herein is true end onrrest.Worfr don@ pursuant to this permit must comply with <br /> cuiront federal,state,end loon!law The drentind of a permit only authgrises approved work end no deviations therefrom.Qevietians must first be authorised in writing from the <br /> @wilding Qffioiei before being authorised under any circumstance.l am the owner,or I am aulhgrfsed by the owner OM properly to perform the work for which application is made, <br /> end i comply with the State Oontrectors law 1841 PgW and P5h:P9011 WAg: <br /> 0 of Sverelt Official Us@ gni <br /> PERM T 7:). <br /> // �a �y <br /> -Owner Au erl$ed Aeon _lanaiure. ate �evreerl O"f@) <br />