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IT <br /> BUILDING / MECHANICALS PILUMBING I SIGN N /SPRINKLER/ DEMOLITION <br /> 411x1CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 f(E)everetteps@everettwa.gmt I www.everettwa govipermIts <br /> (Blue cr Black Ink Only Pleas <br /> PROJECT SITE ADDRESS: 4,03 1 v ?t-- <br /> LEGAL fo;new construction: Snort t'la ,uadi fi iar7li <br /> PROPERTY TAX#. <br /> �.. _ _Lot No. (attach copy of long legal description) <br /> CONTACT- .,I FORM f1ON'�.. ' '''''' . <br /> ,'':. <br /> OWNER NAME: tmil <br /> TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: ,REFc /o3 Io3 td <br /> � srar ' 1 <br /> OWNER PHONE: rim <br /> ^--W V <br /> "" X OWNER EMAIL: <br /> CONTRACTOR NAME: ''` )1.' L 1/L <br /> CONTRACTOR ADDRESS: _ET 1 4 1 o,» ,,tL <br /> � ` t�t, <br /> -.,.." STATE A QIP dr ♦ 20 1 <br /> CONTRACTOR PHONE: "t o <br /> 60 CONTRACTOR EMAIL. t "r 1 -' r/ coal <br /> 4',.ONTRACTt�R-I-IOEt�ISE-�{REf)t1fRE;}i: —. � A. <br /> � fit <br /> 1' �' • �" YPYtf' Vf2�TST attSrf� S"LICE°iSEjRE4tYiRcCrj; j rort_ <br /> PRIMARY CONTACT: 0 OWNER L/CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> To <br /> `^t^ �. CONTACT PHONE: 4.25 259' C S Z <br /> vJ CONTACT EMAIL: • a COI,/ i.„0I � <br /> ..._..ate.eyt�' '�4 <br /> - :,BUIL:cfNC3`pERIVIi AF RLt11iI IL`rittkN MW-TI„ .' > <br /> Exiatin Use of Building: <br /> Contract Price of Work: <br /> posed Use of Builcilw <br /> Bu€idln rvpa ❑SFR_D�ta Iced ❑SFR Heat Source: ❑Gas :aY� ❑Other _ <br /> s Attached ❑p�upley ❑Multi-Famil 4 of Units <br /> I yea_of°`aje^t. ❑New ❑addition ❑Remodel Y � _-_ ❑Commere(al ❑(ndust����ria(������� <br /> DESCRIPTION Oa-WORK: <br /> ePa(f ❑E.(. OSi t ❑Sort rkl r ❑Demolition ❑Cha" _=of Use <br /> `n s ` . f) ;eci_l- <br /> ASSOCIATED BUILDING PERMIT# if a ,e : <br /> 11+'tECIyiANt[CALPF►R tMM <br /> APPLICATION <br /> Type of Project: New Addn pC:�1MB1NlE1{}VI► ''APl1CATi[IN <br /> Alteration Repair <br /> Alteration <br /> + ofType of Project: New Addn t of Fltures ...._ #of <br /> Repair <br /> fix""'rites list afFixtuces—_ *of Fi#trrs--- #of <br /> _ — <br /> MN <br /> AIC—Air({8n�lirtg Units Ixtures Lief-OfFixtures 4iel-of,cixturres <br /> MI Heat Pumr Toilet <br /> alall as <br /> rorced Air Systems 0acktfrat�v Preventer{Inside 8ld 1 <br /> Bathtub Urinal <br /> Water Heater oiler Lavatory(Wash Basin)) FlooriFountain <br /> MillGas FireplaceMIMI Shower Drain <br /> Woad.Stove <br /> Gas Rangeallimi k1tr3Ten Sink Die asaf <br /> MOM Clothes 0 Ditcli Grease Trap <br /> allillier Hookups [Dishwasher Raaf Grains <br /> �Flan*e Hard Other <br /> � 'I' ' Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Oilier: <br /> " PRINKLEWISUPPRESSION SYSTEM <br /> Chemical or Water <br /> 1111111NC. cf Heads <br /> ACKNOWLEDGEMENT.I have reviewed this appticaticn and confirm the information contained herein Is true and correct.Work done pursuant to this permit must complywith <br /> current federal,state,and local law. The granting cf a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writ ng from(te <br /> Building Official before being authorized under any circumstance,l em the owner,cr I am authorized by the owner cf this property to perform the work or <br /> and J comply with the State Contractors Law Y&27 RCW and 296.2001,WAC, <br /> f which a�cpticatler,is made, <br /> City of Everett Official Use CM.? <br /> i L q PERMt` 1 <br /> Ow,artAuthorized Age. iate ure (. ‘C),, ! % �/ f /� <br /> 9 Signature *✓e 4 Y� 1 1 `J <br /> {'� to ...�. , <br /> \_ (Revised 9123/20161 <br />