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PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING/SIGN i SPRINKLER I DEMOLITION • <br /> OLT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 wwweverettwa.gov/permits . <br /> . . i(Blue or Maack Irak ®nly'.l lease) PROJECT SITS INFO ilA`PIORi • •• • • ' <br /> PROJECT SITE ADDRESS: I (c ^ ( I ) % <L7- CIA- f.� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No, J (attach copy of long legal description) <br /> • <br /> • <br /> • <br /> • <br /> • <br /> • <br /> �+- yP. .CONTACT.INFORMATION . '. . . - ' _ . <br /> OWNER NAME: �..,1®I.1-l� �S' (�e(11 2..9-) VL-,TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET -e:D Se, c---2 L 3 • <br /> CITY e`)017-etrt.— STATE OA : ZIPqg C.FJ3 <br /> OWNER PHONE: 0 k:"r�a-,0 -_.._.-..,...m ..- OWNER EMAIL: . .. ...... T...,.w. .•. ,.. -_...,.,., ..- <br /> CONTRACTOR NAME: C UI�Yc.G02.- -r�A 6Tb Tcf off Ca-11�. -c <br /> CONTRACTOR ADDRESS: STREET 2-I)r 0 (i c AU, p� <br /> CITY �=+V m { ( STATE (oV 4— ZIP Et C72-6 <br /> CONTRACTOR PHONE: 1425,2-52-5jl1-/ • CONTRACTOR EMAIL: keldtgQS-5ki-tt•e...lGt.,IP <br /> CONTRACTOR LICENSE#(REQUIRED): ( i 24.'jS 672.20 CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): LI 6 • S' <br /> PRIMARY CONTACT: O OWNER RCONTRACTOR 0 OTHER(Please Specify) NV <br /> CONTACT NAME: CONTACT PHONE: 147c-2-54-5//f� <br /> Ie_.> -14-C-4) CONTACT EMAIL: 11,e_i.A.A Q.5j51n,,u-a- au t-„k___ <br /> • <br /> 13UILDiN©'PRi(/!IT APPLICATION <br /> ExistingUse of Building: I Contract Price of Work:$ 4 Q�j y ,vi <br /> Proposed Use of Building: Heat Source: ❑Gas I Electric ❑other <br /> Building Type: OSFR Detached ❑SFR-Attached ❑Duplex OMulfl Family of Units: l Commercial ❑Industrial <br /> Type of Project: ONew IJAdditlon ElRemodei ❑Repair DTI. OSIgn OSprinkler ODemolitlon OChange of Use <br /> �I'J <br /> DESCRIPTION OF WORK: , c��� 0 _EA k - � Ste51>, u. i yr_t s `E• <br /> ASSOCc____ <br /> IATED BUILDING PERMIT#(if a''Usable: <br /> • •: :►VIECi ANICAL PERMIT APPLICATION ' . PLUIVIEINO PERMIT APPLICATION • <br /> Type of Project: New Addn _Alteration_,Repair Type of Project: New Addn Alteration _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 n Lavatory(Wash Basin) I Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain • <br /> Gas Fireplace Wood StoveKitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting -Dishwasher Roof Drains • <br /> Clothes Dryer Hookups Other: —Clothes Washer Medical Gas ' <br /> Range Hood 'Water Heater Other: <br /> Exhaust Fan 1111 Sink(Service/Bar/Mop/etc.) Other: <br /> SirRiPYLEk/ YiiiPkiEWO.N SYSYEfVi I _MEM <br /> • <br /> s jNumber 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,a local law.. •-gra Ing of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Building Official efore Sing au szed un.•r any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply th the tate C. tractors Law 18,27 W and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ----1--,-/ f i(- - / PERIM v,6 <br /> ODig3owner/Authorized Agent Signature Date t cs (Revised 5/20/2015) <br /> • 1I <br /> 2----z,/ <br />