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PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING I SIGN / SPRINKLER/ DEMOLITION <br /> #111.1144Y..."--A <br /> NaiaiCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> P)425-257-8810 I FAX 425-257-8857 I(E)everettcps@everettwa.gov I www.eyerettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITEINFORMATION ' - -- ' <br /> PROJECT SITE ADDRESS: If 4:1,41*, ST SE PROPERTY TAX#: <br /> ........._._._______ ____._ ....................___.....LEGAL for new construction: Short plausubdivwen Lot No.' (attach copy of 059 legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L''ve Loryl barciD TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET n 7 s 5E <br /> Cir Ever <br /> STATE LA) ii- 61w2o 3 <br /> OWNER PHONE: , 24,i, a 7 q OWNER EMAIL: <br /> CONTRACTOR NAME: CO) "Aea4-tnn c <br /> CONTRACTOR ADDRESS: STREET 1L4I actrtuo <br /> STATE wri- z,pctg2,01 <br /> CONTRACTOR PHONE: L-is 2ct cr.) 60 CONTRACTOR EmAILK- irm ,:, e„, cArolEaftfla cor}i <br /> CONTRACTOR-LICENSE#(REDUIRED):- fgt. --*OE * CITY-OF-EVERETT BUSINESS LICENSE tIfREQUIRED) 411-0faCt g <br /> PRIMARY CONTACT: ID OWNER teOONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 142.6 2.59' (2) s-o <br /> Deb.to Led <br /> c 0 N T A CT EMAIL:0,0349 a e ethino, .coryt <br /> .0, „ <br /> BUILDING PERMIT APPLICATION' <br /> ExistingUse of Buildin : <br /> Contract Price of Work: $ 2O.0 C-) _ <br /> Proposed Use of Building' <br /> Heat Source: *as OElectric 00ther <br /> ............ ............A. <br /> Suildin T pe: 1/SFR-Detached OSFR-Attached ODuplex 0Muiti-Famil 4 ofiUnits: _ OCommercial I:Industrial <br /> Type of Project: ONew DAddition ORemodel ORepair DTI, OSi n OS rinkier ODemolition OChange of Use <br /> DESCRIPTION OF WORK: ,- <br /> Rept arj2_gas -turnack. -1- -r-•,5A-1- <br /> ASSOCIATED BUILDING PERMIT#(if apdficabie): <br /> "17y7e of7-377;t7-7.777v .-- Addt--7—rt'eZ;-----------"-II Repair Type of Project: Ne‘ t:...."'":1 dn ---717,7077-7ier717----------.4 <br /> #of <br /> iSLotEixtures Fi <br /> #of .. --r-tr,fThes -""-------- <br /> List-of-FrxturLista Fixtures <br /> Fixtures <br /> Frxtriter "tc"Ixt"f--- ' xtures <br /> Fixtures <br /> "--------ka-.71t --- i3;7177 ___,r00etT----ThCkfw Preventer k (ITISide Bldg) <br /> Forced Air SystemS Unit Heater Bathtub ----1 -a-----I <br /> er Heater Ther <br /> Gas Piping Boiler ,___._._._tOry(Wash Basin) —71p7i5716 )LTnT '—' <br /> Fireplace <br /> vv-----. ri.—" , ' <br /> _._.____T5i;;z7,,7r __.._ ,1 Drains Kitchen Sink&Disposal Grease Trap <br /> Gas Ran•e <br /> Ro <br /> Ducting <br /> RClothesHOryder .Hookups Other: <br /> "----crV.;TWR'e-EFWr------ ------- <br /> "—T<"r2lai7s"I--Fa-n------------- Sink(ServIce/Bar/Mo /etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM --"------"-----+"—"---"-- <br /> Chemical or Water <br /> No.of Heads "--________--..--------------------------- <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein 1strue end correct. VVork 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!am authodzed by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 16.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P72117------"------------------- <br /> IT () --` 6\2 <br /> Ow,eriAuthorized Age- Signature <br /> Date <br /> (Revised 4/23/2016) <br />