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• <br /> -7001 <br /> PERh [i IT APPLICATIONBUILDING I MECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4011W1 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (clue.®r ilaelt Ink®.n1y_I lease) PROJECT Sk Tt INF®k iv A`PION • • <br /> PROJECT SITE ADDRESS: 5 co StG. Mitlefl MA41 (PROPERTY TAX#: z.ea.6-7 ex:),-se,rop ' <br /> LEGAL for new construction: Short Plat/subdivision of No. (attach copy of long legal description) <br /> CONTACTISI OR➢1R I®I+I • <br /> OWNER NAME: 1-LLL. REAL EST I.(v4A,40 TENANT NAME(If Commercial): B1,+4 tq <br /> OWNER MAILING ADDRESS: STREET 'Zp 514440 <br /> CITY 0(4 424 0 STATE 'D(Y:/ <br /> ZIP LL p 3S-2_ <br /> OWNER PHONE: 6 1 1-- 2 2 <br /> -' " 112$ OWNER EMAIL: t/4IY5hv. ECoNb.CM,atG .a <br /> CONTRACTOR NAME; <br /> nr�..,.cc- <br /> UOR.0 -J ,...6 -re: �, E ,....._......... ..._,. .,.......,....,,.,_..._, ... <br /> CONTRACTOR ADDRESS: STREET '2I20 e t pt.- Au . <br /> CITY ElX(`ff STATE U./A- ZIP iea20/ <br /> CONTRACTOR PHONE: 4ss--2.5.1-�I I. • ICONTRACTOR EMAIL: ¢,e. 1., tA)A .Gov.,, <br /> CONTRACTOR LICENSE#(REQUIRED): EVQ216.6S®2,2,0 r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): fJ 6-1 ey,c5 <br /> PRIMARY CONTACT: ❑OWNER ELCONTRACTOR 0 OTHER(Please Specify) - <br /> CONTACT NAME: CONTACT PHONE: 4'7 C 25-2 v',// I <br /> VA 1 06 CONTACT EMAIL: 'Aka@ � . CIA' <br /> •:� l3lJII.AIIIiIta PERMIT&t�PI.It�►I`ll®N <br /> 'J <br /> • <br /> • <br /> Existing Use of Building: D rttg I Contract Price of Work:$ �, /,./5-' <br /> Proposed Use of Building: N 0 (� Heat Source: CSdGas ❑Electric ❑Other <br /> Building Type: ❑SFR Detached CISFR Attached ❑Duplex C1Multi Family#of Units: CCommercial ❑industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel I Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 00E, eF,,G"P 4Ac. R-tvi5 ©r( ( tA, <br /> (ZEMM � ,e) /11( Ihurt5 LAWS co/-.liIce <br /> 6Awxe. locuttttNO , 5 t ,(c,n fActli I W tz((N4T <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 11 <br /> . I i . PLuna6IHG PERMIT APPLICATIOM • <br /> .: _ .ME-cI ANIC#1�.OEtutlr`I'APPLIdA1TIOM _ __ <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 #°f 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 PipingBoiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri• geration Shower Floor Drain <br /> Gas Fireplace - Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains • <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Wafer Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> :- IiiRlf.iffiKLEki SIJPP.FiESSION SYSTEM . ' <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (V° 441 j 5t 1 g <br /> PERMIT 4 Dui <br /> r, h <br /> U <br /> Q.urwertAuthorized t Signature Date (Revised 5/20/2016) <br />