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K , PERIII11TAPPLICATION <br /> BUILDING I MECHANICAL 1 PLUMBING I SIGN I SPRINKLER/DEMOLITION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425257-8810 J FAX 425-257.-8857 J(E)everetteps@everettwa.gov J www.everettwa.gov/permits . <br /> 0§Nia•®s'ictal (f ak®r11301ee) ' : ' PRQJJECT SAYE INFO 11ttATIOtc •,•' •• ' <br /> PROJECT SiTE;ADDRESS: "7 i 1v'lixrzsz 1,,4‹....1 !PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: e. (A-01,S r _ TENANT NAME(if Commercial); <br /> OWNER MAILING ADDRESS: srREEr _._� • <br /> 1 cur --- STATE ZIP , / <br /> OWNER PHON 4,1' « OWNER EMAIL: <br /> CONTRACTORNAMEc —.,EU .W I\J.� ,..6Tt T( . . , 6.L1..04 .... .. _ .. , ,..�v....,.,„_..-. . <br /> CONTRACTOR ADDRESS: STREET 'Z1 .- AAC.--1 Ftt., AU gr. <br /> �} <br /> CITY V STATE (A A-. ZIP p CS2.0 <br /> CONTRACTOR PHONE: 4'2-5•,,2- 2,a5//q • CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED): EQi 2 .35®2,,p T CiTY OP EVERETT BUSINESS LICENSE#(REQUIRED): 4.5 6, ? -C • <br /> PRIMARY CONTACT: ❑OWNER gyCONTRACTOR 0 OTHER(Please Specify) ' <br /> CONTACT NAME: CONTACT PHONE: 4 75„2.5-2.a,//f� <br /> V1' LAt L.o CONTACT EMAIL: <br /> . 1. .• • .• •.. ,' b(ni,f iple Ofilirr ii.OP.LitArrioisf ' ' • • .• : , • <br /> Existing Use of Building: i cW � '''dProposed Use of Building: (Heat Source: f as ❑Electric ElOther <br /> Building Type: CJSFR-Detached °SFR-Attached ElDuplex OMuIti FaContractmily#Priofe Units:ofork;$ <br /> VCommercial Ellndusfrial <br /> Type of Project: ❑New ElAddition URemodel ElRepair ❑T.I. ElSign OSprinkler EJDemolition ❑Change of Use <br /> DESCRIPTION OP WORK: 1A_ uN 1.1. \4e -r �f 640,..(,e • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> : : :MEc ANxcAL t Riil1tT'.Aiipue; T KON . IPLUMEIMB P2RIifIIT AiFPLIG.ATI1O1 • <br /> Type of Project _New Addn Alteration_•Repair I Type of Project New Addn Alteration Repair <br /> #of List of Fixtures I d of List of Fixtures I #of List of Fixtures 1 #°f <br /> Fixtures EEEE Fixtures i Fixtures , Fixtures <br /> LlstofFixtures <br /> j A/C—Air Handling Units ! Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems ; Unit Heater Bathtub Urinal <br /> Gas Piping Boiler i 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 101111 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.), Other: <br /> 1. <br /> '• : :•S1P1f VN LE1 1 .1.0pR SIII© Y sYYTeM 1111 <br /> J Number of Heads <br /> 4CKNOWLEDGEMENT.'I have reviewed this application and confirm the Information contained herein Is true and correct.Work done pursuant to this permitrnust comply with <br /> :urrentfederal,state,and focal law.The granting of permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> ?uiiding Official before being authodzed under any circumstance.I am the owner,on 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 Law 18.27RCW and 29U.200A WAC. <br /> City of Everett Official Use Only <br /> /24.,\..."..s....g \ <br /> r, <br /> I ' t)tAl— a) \ —a <br /> PERMIT <br /> wneriAuthrIzed Agent Signal ore Date (Revised 0/2016) <br />