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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I SIGN I SPRINKLER/DEMOLITION <br /> j4_ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everetiwa.gov www.everetfwa.gov/permits <br /> (Blue or ack I k Only_-Pleased F . .A JEC lr SIT ifl!1�1Ft MATIO ,r <br /> PROJECT SITE ADDRESS: (L:e S.' 5—'7 `" - ?W PROPERTY TAX#: QLD ale l00 c i 000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: 13(1.4„, LY{nth TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET S S 74 j <br /> cry E { r u A C/ STATE ZIP Ca2t9..? <br /> OWNER PHONE: L(2.) s-',j •- )(57.3e4 OWNER EMAIL: J-'(/ <br /> CONTRACTOR NAME: /(/OA) 1304; {, (` L. C. <br /> CONTRACTOR ADDRESS: STREET ( - 141,,,e_ iv <br /> CITY r U'1,41yel STATE L ZIP.. L Gi G <br /> CONTRACTOR PHONE:1-425-- IF-Cj L(5 CONTRACTOR EMAIL: /1V4-41 ; q tra(', s f .c,opt, <br /> CONTRACTOR LICENSE#(REQt1IRED): � jY 13L„5 55} CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):s?1 ' <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C.I - 3— tea--/ <br /> L y'14,1,"„tn CONTACT EMAIL: ,r <br /> i,t im,.. 3 k i�,.e., e }" `° �'�. �: t r L■x 4+'M"� "1p f .e i,�,y.,�, i IM <br /> .r., z_, ,.,.,.. .e: .„.... ry 4.'.. 1BUt1! II ..,�.�..arvE�,�R��JPeii���l�� �Lr��i� '�� �; k 'E '+'hh '4 S <br /> ,. �, f .,...... ,,.�._.,,m�.... ..r v�'� .�s„a. ..'�..Sa,.m.ads+�: _.,'" a'�i.'. , �...� k..i <br /> Existing Use of Building: Contract Price of Work:$ I v d 0 .— <br /> Proposed Use of Building: Heat Source: IS7Gas ❑Electric °Other <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex OMuiti-Family-#of Units: °Commercial °Industrial <br /> Type of Project: ❑New ❑Addition °Remodel ❑Repair DT.I. °Sign ❑Sprinkler °Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . VIEC ANICAL l.ERMIT AP . CAT`ION1WgPLUMBIN a PERM T !PLIC„ <br /> Type of Project: _New_ Anda _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of 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 Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> I 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 /> >SPRINKLER I SUPPRESSION SYSTEM . , <br /> Chemical or Water I No.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.1 am the owner,ort am authorized by the owner of this property to perform the worts for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WRC. <br /> City of Everett Official Use Only <br /> • CI lS f I"7 PERMITnWW0/.. l JVJ <br /> A..4..nrf AA <br />