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PERMIT APPLICATION <br /> 0w_,-- -----. . BUILDING i MECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> 'miwy CITY OF EVERETT PERMIT SERVICES <br /> T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 !wweverettwa.gov/permits . <br /> (il[ui€�®rbfa c Ink anlyP[ease) • • • PR. JECT SMTh INF ivIAT1ON • •• • • •• . <br /> PROJECT SITE ADDRESS: '771)0 4.6.e .t t,u4' PROPERTY TAX#: t#'n. 300 ci 3300 ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ ..CONTACT'INFORMATION . '. . . • • ••• . , . . <br /> OWNER NAME: (dr)(AJ10,2„-At(cl2Z RF--".\i• �'1.4' ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET 1/00.�r�-,O(/l=/ /tel A r� • <br /> • <br /> CIN Jy(/1=•t ( STATE (,I'�n ZIP ?•7� <br /> OWNER PHONE: 1 '� OWNER EMAIL: �s <br /> CONTRACTOR NAME:+M�+FE UidYQ - AJ._,...67- C( r... 6 T& -A-c. .,..r......... ,_ .............. ..,,.. . ,.. <br /> CONTRACTOR ADDRESS: STREET °-I 2-0 PAC-1 ft-C- A()g" . <br /> • <br /> I'! 0U Mull- STATE (iV - ZIP /4320, <br /> CONTRACTOR PHONE: 4`z5-f` c•2 /51 i 4 • CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): e()61245S® 2.0.r ICTTY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4,..)6-7 gy 5-5 <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 475-2-5-2-W/9 <br /> Mme- f fr CONTACT EMAIL: / 1„5'9404.14., <br /> .• •. • . • . . ' • DOWING-PERMIT APP•1!icATION • • • - . . • . . . <br /> Existing Use of Building: eirfiGiC <br /> Proposedl Contract Price of Work:$ 9tmo <br /> Use of Building: /V Gt� Heat Source: ❑Gas •Electric ❑Other <br /> Building Type: ❑SFR-Detached @SFR-Attached ❑Duplex OMu(ti Family#of Units: l�Commercial ❑Industrial <br /> Type of Project: ❑New DAddition EIRemodel 4�1Kepair OT.I. ❑Sign @Sprinkler @Demolition @Change of Use <br /> DESCRIPTION WORK: M J>/56 � 1/44( <br /> , /45 . Z-,044477/1-") e40,064rf aif3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 6V1ECI .ANICAL,P.ERii(IIT APPPLICATION . • - . PLUIV.IWIC�46 PBRIi�ITi APPLiCATION • <br /> Type of Project: _New Addn _Alteration / Repair Type of Project: __.New Addn Alteration Repair <br /> #of List of Fixtures °f List of Fixtures #°f 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 /> / { <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration 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 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> : :"SPRINI(Ll R/SIJPPRlESSION SYSTI VVI . ' 1 <br /> Number 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,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.tam the owner,ort 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 98.27 RCW and 296.200A WAC. <br /> (� p City of Everett Official Use Only <br /> (� 0 3/, ! PERM \q� D-o. <br /> Qty/Authorized Agen ignature Dat (Revised 5/20/2018) <br /> 2- <br />