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04.°TPERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION - <br /> 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@everettwa.gov I yAmmeverettwa.gov/permits <br /> (Dfuie•(ir 1BIack Ink Only.please) ' .PROJECT SITE INFO IVIA`rION •• .• <br /> PROJECT SITE ADDRESS: 2503°% (-4- uut'f' AUG- PROPERTY TAX#: OO 734 5 Oo& <br /> LEGAL for new construction: Short Plat/subd(vtsfon Lot No. (attach copy of long legal description) <br /> OON AGT INPORMAT1OIs • <br /> OWNER NAME: C.Gtr'T✓1-O M t 00• TENANT NAME(If Commercial): E.LK4TY2✓4 I N t ,ld-c- <br /> OWNER MAILING ADDRESS: STREET 2S 3 �-Z t-(-6w r.-('f" 14.-06 • <br /> CnY GVt T STATE WA- I' ZIP Re 20/ <br /> OWNER PHONE, 'f 2r - 7, .. . 46.1 y._.,., •...,....« OWNER EMAIL: 5 G(Ot>0 0 C k STi2owi teve0 UAB <br /> CONTRACTOR NAME: E UOR..C. A..✓ a TAT( E' <br /> � (ct-7-A/LP--A-C. <br /> CONTRACTOR ADDRESS: STREET 2-12,0 04C-telt- AU tr • <br /> '` �s <br /> onY GUfG STATE W ZIP Et 42120/ <br /> CONTRACTOR PHONE: q` 5-2-5 2..15//44 • (CONTRACTOR EMAIL: MWla-(c @ ISS 04 wtA •G 014 <br /> CONTRACTOR LICENSE#(REQUIRED): CO .VS 02.2,0 T- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 6;7 e/ST • <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: t4 7 5--j,5-2. //f9 <br /> v\0\14447,O.iJ CONTACT EMAIL: M,Lv4 . , <br /> - - B011..DI14 P RMIr APPLICATION • • • • , - <br /> 4.Existing Use of Building: M PAW i Contract Price of Work:$ gRgv.OG <br /> Proposed Use of Building: WO 644-$)6f Heat Source: ,g!Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached OSFR-Attached ODuplex CQMulti-Family-#of Units: RCommerciai I:Industrial <br /> Type of Project: ONew OAdditlon CiRemodei L¢IRepair OT.I. CDSign OSprinkler C(Demolition ClChange of Use <br /> DESCRIPTION OF WORK: ✓a i 64 w vic-iN b UN>T Okra I IJ s 010 3 , )/ • <br /> ti.v t:±- e,oe6 eo11, “r av 11 2- 5Tiaets a03,5 V /'a- <br /> ASSOCIATED BUILDING PERMIT#(if ap.iicable: <br /> • <br /> iviEbi4(juitilcAL PERMITAPPLIcArION • • , PLUMVIi WNG PERMIT APPLICATION - <br /> Type of Project: _ New Addn Alteration r Repair Type of Project: New Addn Alteration Repair <br /> #of List of Fixtures °f List of Fixtures °f List of Fixtures #of 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 HeaterRefrigeration Shower Floor Drain . <br /> • <br /> Gas Fireplace - Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains • <br /> • <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 /> •SPRINKLLEi /S.UIPPRSSlONSYSTEivi <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/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 underany circumstance I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law l a27RCW and 296..200A WAG <br /> City of Everett Official Use Only <br /> PERMIT# <br /> '...\\Q <br /> ,Gwret/Aufhoriz Agent Signature Date (Revised 5/20/2018) <br /> 1 <br /> • I� Z � <br />