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• <br /> PERMIT APPLICATION <br /> r "Irrmil:::001,--wvil• _ BUILDING/MECHANICAL I PLUM!:INO I SIGN I SPRINKLER I DEMOLITION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits , <br /> (HIue.®r IUiack Xrik Qnitlple�s©) • • PROMO' INFORMAil'XON • • • ' <br /> PROJECT SITE ADDRESS: /06, - 7/M /r Ye- PROPERTY TAX#: ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long regal description) <br /> CONTACT ik�IFORIVILAT1Ok�I • . •.• . • . <br /> . <br /> OWNER NAME: Z4 lt-'ti U' 4/1I( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sneer r()&.-- 7c3 NI /, S8— . <br /> CITY — 1:1'_fo STATE (OA ZIP Q C) O3 <br /> OWNER PHONE — <br /> � l OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> E kj'� , <br /> ( ,,�QJ~.,_.67-0,-TGf "7 E AIGIA-t ..,,._...,.... ,�_.�_..... w. .... ... . ....,� ,. .,.,.� , <br /> CONTRACTOR ADDRESS: STREET 2I 2-0 044 Pt. iSc()0 <br /> rr SU6(2triT STATE l VA- ZIP 6t 77219/ <br /> CONTRACTOR PHONE: 425•2.5°`2.'3 // • JCONTRACTOREMAiL: .42 44-04.10'S-5,14 l-Ly, d('1 <br /> CONTRACTOR LICENSE#(REQUIRED): E (e,SS®2.20 _ cITY OF EVERETT BUSINESS LICENSE#(REQUIRED): E5 6 ? 5- <br /> PRIMARY CONTACT: 0 OWNER JaCONTRACTOR CI OTHER(Please Specify) ,.•,._" . <br /> CONTACT N • CONTACT PHONE: 4 2�„ '2- /f <br /> 51 <br /> A-1 <br /> Ycl-(_,v CONTACTEMAiL: I '- - , <br /> .• ,, BUILAMIiIG*p R[ViITApP•LIcAT1ON ' '. . ' - •• • • • :. • ••, • <br /> Existing Use of Building: I Contract Price of Work:$ R�Qn, I/4)Proposed Use of Building: Heat Source: <br /> EI tectrlc Dottier <br /> Building Type: FR-Detached OSFR-Attached ❑Duplex OMultt Family#of Units: DCommerclal Olndustrial <br /> Type of Project: °New °Addition °Remodei Ktepair OT,I. DSlgn °Sprinkler ClDemolitlon °Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if ap i Iicable: _ — <br /> ,: , ..iuigC11.A Xc4U..PEI MiT APPLIcATIONN f . ' • . . PLU1V1BiN®PleRIVIXT APPLIIGATIOM <br /> Type of Project: _New Addn Alteration_Repair Type of Project:^New Addn ._Alteration _Repair <br /> #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures r., List of Fixtures , <br /> Ffxfures Fixtures Fixtures ures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 /> :'SPRi WLEk 1 SUPPI1.I65SIO SYSTEi1UI - ' <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 end no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance,/am the owner,ori am authorized by the owner of this properly to perform the work for which application Is made, <br /> end/comply with the.9 fa Contractors Law 18_27 ROW and 296.200A WAC. <br /> 1 c City of Everett Off/clot Use Only <br /> PERMI e <br /> lqt <br /> D....04(p <br /> owner/Authorized Agent Signature Date (Revised 5/20/201k) • <br />