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• <br /> . PERIIIIIT APPLICATION <br /> "MP' BUILDING I MECHANICAL/PLUMBING/SIGN i SPRINKLER I DEIIIIOLITION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 . <br /> (P)426-267-8810 1 FAX 426-257-8857 1(E)everetteps@everettwa.gov( wrwv.everettwa.gov/permits . <br /> (IdNi®.®rr if3fa&c link K rs(k'.I rees©) . : . f ROJEOT sut r,NFO.NIVIAtiek •.•. •• • • <br /> PROJECT SITE ADDRESS: 4/5- ,_516---; ,�i/ rAlt -/4-4/6< !PROPERTY TAX#: 1 <br /> I <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> COMM GT 19 'Ok M TIWI ' ' '. • • . . .• <br /> OWNER NAME: ,o ,� ,cd ,44,I-L (r ' k_-TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /,//j se 0vix !r!/`4'L . l.4. -c • <br /> an, STATE -�, ZIP g' i l <br /> OWNER PHONE: 1/�/ OWNER EMAIL: . <br /> CONTRACTOR NAME: C U cl,k69,56AJ ,.•6mm( 04,61 <br /> CONTRACTOR ADDRESS: STREET I-I`U6(24711- <br /> T-0 P 1,�fi: iU <br /> gr <br /> • <br /> CITY r/6YW 6 { STATE Uf A. ZIP 2Z <br /> CONTRACTOR PHONE: P4`z5>2.51-°'(II . 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): W(,L`}2( S&2.2.0 r ICTTY of EVERETT BUSINESS LiCENSE#(REQUIRED): L•)6 .- "5- <br /> ..•e.•r•r:-n.i r r+w-.x.4+-'Y�,M,H+•.n._.Y...wn.,1 uN--w. �t r..rte.-.w+,✓ 4+.n.nxsv •n.."a ..L .+•......tr. ,i.w,a_..,..w-.,ww„y Y . r'--Y.-..•n.nua.ray.r..:.. v .-,•Td(J:�� <br /> PRIMARY CONTACT: ❑OWNER aCONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME: J CONTACT PHONE: 142 g5' .2.5'2....,11 9 <br /> .1/L- -k, S'-Lo CONTACT EMAIL: <br /> : . ' '• .60.0.6(0(a pWififilT APPPLi dA`rai®id` ' • , • ; ':—- <br /> Existing Use of Building: / Contract Price of Work:$ 2i <br /> Proposed Use of Building: Heat Source: ❑Gas ,Electric [(Other <br /> Building Type: ❑SFR Detached CISFR-Attached ❑Duplex EIMultl-Family of Units: [(Commercial Elindustriaf <br /> Type of Project: ElNew IJAddltlon ;E lRemodef ❑Repair ❑T.I. ElSign CiSprinkler ClDemolltion ElChange of Use <br /> DESCRIPTION OF WORK: GvL/11-- -e, vr, C,- r.^i,t11 . <br /> ILIgE. -14 /4.411 -U1i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): &led ` /' ' • 0' '14 A_ t t 1 1 <br /> • .114ECr-1,iii4CALL.AtlrrTAOPLf AT r®k\V ' ' . Punn6JNG OEFifinrr APPLiCATI1•AT • <br /> Type of Project: __New Addn Alteration Repair Type of Project: New Addn Alteration ,Repair <br /> l #of List of Fixtures #of List of Fixtures '#°' List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures j Fixtures <br /> ! A AIC-Air Handling Units Heat Pump ! i Toilet Fixtures Backflow Preventer(Inside Bldg) +I <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping I Boiler , Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater • Refrigeration Shower Fl• oor Drain . <br /> imuisuitim Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas RangeDucting Dishwasher Roof Drains <br /> i <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas ! <br /> Range Hood Water Heater Other: <br /> 1 Exhaust Fan Sink(Service/Bar/Mop/etai) Other: 1 <br /> 1 <br /> .-§Tta'RMYKLEk %SUPR'eppr@N SYSTEM <br /> [Number of Heads <br /> CKNOWLEDGEMENT:i have reviewed this application and confirm the Information contained herein is true and correct Work done pursuent to this permit must comply with <br /> urrent 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 /> luilding Official before being authorized under any circumstance,I am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> nd I comply with the State Contractors L 78.27R n 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1PER71ZV. <br /> ismer/Authorized Agent Signature Date (Revised 6 /2078) <br /> , <br />