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PERMIT APPLICATION <br /> :ifer...------ ,, BUILDING i MECHANICAL I PLUMBING I SIGN 1 SPRINKLER 1 DEMOLITION • <br /> CIDt'OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> `— (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@evereftwa.gcv l wwweverettwa.gov/permits . <br /> (1111X®'®r 131hcla ink®.rill] legis e) - • PROMO' JNFO,• MiATkORt •.•• • . - ..... .__ <br /> PROJECT SITE ADDRESS: /34'4MIfF�/, �( e/1- VA, !PROPERTY TAX#: ' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . . ..CONTACT Win:4 AT ii . • :.' <br /> OWNER NAME: /i 4-4,t ,— ,Atet TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smeEr /.3Wt- kfttgu.--rwc, 87 l(1 dr • <br /> CRY <br /> thrareirr STATE Wer', zip q- ZC^/I ' <br /> OWNER PHONE: 4/261- ....,^q tir..,. .,...�.,_ OWNER EMAIL: Al. .. .. .. ..?'...n, .. .b ...� .......,.� .... a <br /> CONTRACTOR NAME: E U .Co( � 5`rorT( 6`,' e'er b4 7'r <br /> CONTRACTOR ADDRESS: STREET '2-f`?it) f <br /> Et Ac), . <br /> ctTY .0 ucceurr STATE (ti _ zip 1tage/ <br /> CONTRACTOR PHONE: 425,2.5'2_./3 II14 • !CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 0O`yZ6•55 02,2,0 o' !CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4.5 e ,S'S' • <br /> ... w.•.9.n•�- -�i -. ...M+n+..1.P••-.•rY w.y.w...........'.+Y.•.s+.r.rw.4.wn�wwe..a.e«4rn4.4.W..V...+F..-�.nx.n..n.....nc..rM...vw-+s.rr ...rwa a... . . .........n. Jr�nr.....r. . �•••r••• <br /> PRIMARY CONTACT: D OWNER ]$CONTRACTOR D OTHER(Please Specify) . <br /> CONTACT NAME: l(. -- �°r�. CONTACT PHONE: 4 7 5-24'2,.',//9 <br /> ....._............................... CONTACT EIV(AIL:-......................................................................_..._.........._. <br /> - . • 't.. •• `• i31JIL614CaO f1TAPP.LICAT1ON • • • ,-• . . . , • : ... • <br /> Existing Use of Building: 1 Contract Price of Work:$ 2•,�tfi1)r <br /> Proposed Use of siding: Heat Source: 7Gas I:Electric ❑Other <br /> Building Type: SFR-Detached DSFR-Attached ClDuplex C(Multl-Family-#of Units: I:Commercial Elindustrial <br /> Type of Proj t: ONew I:Addition ClRemodel Lepafr DT.I. DSign OSprinkler DDemolition I:Change of Use <br /> DESCRIPTION OF WORK: <br /> goek46.- au.)s Ft-taKm.-- ,..ctu 1.45-4,i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> •• ; AVTEcHAN1C.AI!FMRM1T APPPLICAT tO . • • . PLUMgflIG KalEiglifilit APPLYCATI®, • <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 /> NC—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 /> 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 Wafer Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> Number of Heads <br /> ACKNOWLEDGEMENT•I have reviewed this application and confirm the Information contained herein Is true end correct.iii/ork 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/n writing from the <br /> sus/ding Official before being authorized under any circumstance.lam the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State nfracfors Law 18.27 W and 295.200A WRC. <br /> I 0/6 _5- if-lf City of Everett Official Use Only <br /> PERMI <br /> if 1 i 1:10 ° D <br /> :wner/Authorized Agent Signature Date (Revised 6/20/2016) . <br />