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PERMIT APPLICATIO■►. <br /> ilittilIP:/--- BUILDINECHANICAL/ PLUMBING /SIGN I IIRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everette s everettwa. ov www.everettwa. ov/ ermits <br /> Ip@ 9 I 9 P <br /> (Slue alit Black lflk,Only Please) PROJECT SITE INFORMATION ... <br /> PROJECT SITE ADDRESS: J 1400 WA- . 0v- i „ . arg7._(PROPERTY TAX#: 06441'210000�1 402. <br /> LEGAL for new construction: Short Plat/subdivision e.,V G��!' I . "6. 1 (attach copy of long legal description) <br /> . C©N'TACT INIFOR(( TIO l <br /> OWNER NAME: \A(,-M44 (ZEALvislivrE StI,S1)J TENANT NAME(If Commercial): awcra{,Fr Ametes, _ <br /> OWNER MAILING ADDRESS: STREET -17-141- 200! 1D'TIf Sf <br /> CITY '5E 1701QVILLE STATE ,QA. ZIP 72? I i, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1".6P <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR LGIOTHER(Please Specify) 1ACk f t/E'/Tt 1 _ E [iziP�/�Lt <br /> CONTACT NAME: CONTACT PHONE: 4,10 o� �`' <br /> D42.4.•51314 , CONTACT EMAIL: S'I,L z.G ei J. C.Dy '1 <br /> BI.I m)04.0 PE[r MIT APP'#, A'I`IQw -` <br /> Existing Use of Building: MA Contract Price of Work:$ 501 Oa). <br /> Proposed Use of Building: 14A Heat Source: ❑Gas 0 Electric ❑Other 14/Ar <br /> Building Type: ❑SFR-Detach d ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New MAddition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: fretL .no4 or avcroL V`, oGb.#4bT�t4 <br /> tN eSttsTub WALMA2IP.404446. 1-01". S/ f10E- Cl-0S L <br /> • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IIECHANI ALPERMTAL CTIONN, L M I , PERMITAPLIATIONyPP , P . , <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of 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 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water ' No. 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 b-fore being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comp/ .'ith he State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER115;"tt <br /> ..---- ('•25. I8° ' SOC-6 a <br /> Owner/Authorized Agent tgnature Date (Revised 9/23/2016) / j <br />