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PERMIT APPLICATION <br /> BUILDING 11U1ECHAN1CAL I PLUMBING/SIGN i SPRINKLER I DEMOLITION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gav/permits . <br /> (ilius.or h1ack itch Cc�'rnjitpi®_se) PR?JILT SRT iff4F00i1VI TION • .. . - <br /> PROJECT SiTE ADDRESS: ' I I t st (",-( wL1t-I— - i PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivisioonnLot No. (attach copy of long legal description) <br /> — • . . .. . • .coNtAdtIl iir®Ngl�ATI� 9 • - . -. . . . <br /> • <br /> OWNER NAME: A I Co 6C(' / TENANT NAME(If Commercial): , <br /> OWNER MAILING ADDRESS: srhEEr 2-R f t 12 t. 'T" 44 1 • <br /> cm, EV La/S STATE CA-Mr t ZIP q 720 C <br /> OWNER PHONE: la -,;�L7;• -el/., A' OWNER EMAIL: <br /> CONTRACTOR NAME:. C 0 a:�vV Mik.„) 61'eT ._ freeryt2�`!�,-c-..... .... . ._,..a. ........ ..._. ... , ,„, ,_w K...., <br /> CONTRACTOR ADDRESS: STREET °2-I'2-0 <br /> 4(.l Ac()gr y <br /> cn' -FLT V 4i STATE W A— Qy ZIP 2-d <br /> CONTRACTOR PHONE: 4s5,2.5-2.-5II.j . CONTRACTOR EMAIL: e d..e,5Sp'Lt tc.e2, 7 -. . <br /> CONTRACTOR LICENSE#(REQUIRED): E(,)1 s p•21„0"t" CITY OF EVERETT BUSINESS LiCENSE fl(REQUIRED): 06 r -5- • <br /> PRIMARY CONTACT: .0• <br /> OWNER �M . <br /> 1CONTRACTOR IA OTHER(Please Specify) N w.w . z_._• " ""'"._e-.._,.. <br /> CONTACT NAME: ,-� CONTACT PHONE: .'2- -,ll <br /> (� _) C� CONTACT EMAIL: <br /> Existing Use of Building: <br /> �1114) 111�IIt � tld1� �;�I,r��, i�rei <br /> I Contract Price of Work:$ t / � �U <br /> Proposed Use of Building: Heat Source: Gas DElectric OOfher <br /> Building Type: @SFR Detached OSFR-Attached @Duplex Multi Family#of Units: immerctal Cflndustrlai <br /> Type of Project: @New @Addition @Remodel I:Repair OT.I. @Sign i:Sprinkler @Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: f7 � � ��� I��I�� /�S c� � <br /> ASSOCIATED BUILDING PERMIT#(if applicable: <br /> • , .[V(• GHANtcAL,Pl Rtil111T.f PPL1c Ti®m . - • , IPLUMW MG OaglinIft APPLICATION <br /> Type of Project: _NeW Addn Alteration Repair j Type of Project ^New Atkin Alteration Repair <br /> 1 <br /> #of List of Fixtures '"of List of Fixtures #of 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 /> 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 /> : :•SIfiR,iOI L.ERI 0P1P1l SSI® Y SYSThMVI 1 i <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 and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,ort am authorized by the owner of this property to perform the work for which application Is made, <br /> and I comply with the State Contractors L. 16.27 RC ..200A WAC. <br /> City of Everett Official Use Only <br /> � � �` �� PERMIT# I l �� / <br /> owner/Authorized Agent Ignafure ale <br /> (Revised 6/20/2018) <br />