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PERMIT APPLICATION <br /> . �° d BUILDING i iV1ECH.ANICAL 1 PLL111i1BING/SIGN/SPRINKLER/DEMOLITION - <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-251 8857 I(E)everetteps@everettwa.gov I vm..everettwa.gov/permits <br /> (B(u,1®.®4-bfack ink only/,g7le se) • : / ' PROJECT SIITI IINFO•--.11011111014 • • • - <br /> PROJECT SITE ADDRESS: „5't)C AA-,Li J (•j' PROPERTY TAX#: ! <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> -- - ------- <br /> • <br /> . • • <br /> •CO ltAdY• ..Iii0ORPIATt®�'I . •' • . . . • <br /> OWNER NAME: / • " 1 A-Z Zfji- -- TENANT NAME(If Commercial): <br /> OWNER MAILiNGADDREss: smmeEr At _ rl.c..c.. r • <br /> I • <br /> CITY r V, --- ---- STATE Ac ZIP q <br /> 'OWNER PHONE: %O .- /g 4; OWNER EMAIL: 4 <br /> CONTRACTOR NAME: E MZ - AJ 6 TA-Tr fiCtr 1M -C. <br /> CONTRACTOR ADDRESS: STREET 21 2-O &. AU Gr p <br /> CIT[ .2 )6 STATE (ti! ZIP p S'- <br /> CONTRACTOR PHONE: 1425.25 2-'5// • CONTRACTOR EMAIL: evl. s £XS w4{„G`d <br /> CONTRACTOR LICENSE#(REQUIRED): VA`YZP•$S 0.2Zv Z` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 6 r <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR El OTHER(Please Specify) • <br /> CONTACT NAME: , CONTACT PHONE: 142 s--7-5'•x..',//f¢ <br /> K- �, ,S,-t—ill CONTACT EMAIL: <br /> 1L.HtNG P R1(tiIT APPL[CA`TIOtd • 'f. •• . • •• •_ ' <br /> • <br /> Existing Use of Building: i Contract Price of Work:$ lei N670, <br /> Proposed Use of B (ding: Heat Source: ❑Gas t lectric ❑other <br /> Building Type:. FR-Detached OSFR-Attached C°Duplex ClMulft-Family-#of Units: E!Commercial ❑Industrial <br /> Type of Projec: ❑New ❑Addition ElRemodel ❑Repalr 01.I. EISlgn I:Sprinkler Cf Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: T10 :-r14 u- Ne/ 14-ei4T `1 :i- Syr" ' <br /> ASSOCIATED BUILDING PERIVIIT#(if applicable): <br /> lVIEcif-ii.NIlcA1L•PHRIVII T APpiug-iwrgeiiv �ll.�MIB66�[ � �il(I!T APP LtC �t®1( <br /> Type of Project: New Addn Alteration Repair I Type of Project:_Naw Addn ^Alteration Repair • <br /> Fixtures List of Fixtures f Flxfures list of Fixtures ' i Fixtures List of Fixtures ;Fixtures <br /> List of Fixtures <br /> A/C— Air Handling Units ; I Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> j Forced Air Systems Unit Heater Bafhfub Urinal <br /> Gas PLing Boiler j Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> I Gas Range Ducting Dishwasher I 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 /> .ako:R J1YF t..Et i41•14 E•P.t®N9 SlY rE11t1 <br /> Number of Heads <br /> CKNOWLEDGF-MENT.•I have reviewed this application and confirm the Information contained herein is free and correct.Work done pursuant to this permit must comply with <br /> went 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 /> eliding Official before being authorized under any circumstance.lam the owner,orl am authorized by the owner of this property to perform the work for which application Is made, <br /> Td I comply with the State Contractors Law 18,27RCWand 29C.200A WAa <br /> f f City of Everett Official Use Only <br /> ( Lvf.ff w-� PERM . / D O� <br /> veer/Authorized Agent Sign�tn Date (Revised 5120/2018) . <br />