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"W. <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN i SPRINKLER I DEMf O UTION • <br /> CITY OF EVERETT PERMIT SERVICES <br /> _, - T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (F')425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits . <br /> (I§Isla•®w i3I2YeC'Mk®.tai reffi e) . • pROJl OT S Tk 11NFO,' M A k/ , <br /> PROJECT SITE ADDRESS: 3 5 2 S 6 o(6 PROPERTY TAX#: ! <br /> ,LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> ,COQ6A�� II> ®li�l `IIN k� • . . , <br /> • <br /> 'OWNER NAME: 13t•ZCt. -. KwLA f..,J 11 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 Z5 (t `i.)\ r 'A C�/r?, <br /> j cm LV c. [( STATE W , ZIP ` a -7-44 <br /> t <br /> ;OWNER PHONE: DOWNER EMAIL: <br /> � � • <br /> CONTRACTOR NAME: liC.7,,.(� AJ 6 r Tt( �f-f c'e( r-G <br /> CONTRACTOR ADDRESS: STREET 2I Cil ft.e., Au g <br /> 1TY sUaltnT STATE (1j'4... ZJP /S20 <br /> CONTRACTOR PHONE: 4s-5.-2.5 2--3/i • CONTRACTOR EMAIL: fre i4 pt'•5•YLC,,rot.,, (81,--+.-- <br /> CONTRACTOR LICENSE#(REQUIRED): Safi 5s p2,2.p^f' CiTY OP EVERETT BUSINESS LICENSE#(REQU6IRED): o 4: ' • <br /> PRIMARY CONTACT: 0 OWNER 1 .CONTRACTOR CI OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: 475e.25- . //9 <br /> CONTACT EMAIL: <br /> • 13LT101.14G 0RMIT ApP,L(WA`!PI(®Nd • • • • •` <br /> • <br /> Existing Use of Building: Contract Price of Work:$ -'%• <br /> Proposed Use of Building: Heat Source: EIGas lecfric DOther <br /> Building Type: DSFR-Detached DSFR-Attached ElDuplex DMultt-Family#, of Units: 94ommercial Dlndustriai <br /> Type of Project: UNew DAddition DRemodel L-e.air DT.I. EISI•n DSprinkier EiDemolitlon DChange of Use <br /> DESCRIPTION OF WORK: G fl,iA.- 1,0 b---4..3 Co Lc 1 ()h. (AN- t'? 6,1,04 v...o (Q , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .iUIRCHANIC. 1L Ftiti illi`>i'APP11,UC. TION . PLUIV.16ING kialtilifilt APPLICATJ•'t _ • <br /> Type of Project: New Addn Alteration_,Repair Type ofi Project: _ New Addn _Alteration Repair <br /> Fixtures List of Fixtures I Fixtures List of Fixtures Fixtures ListofFixtures Fl ores List of Fixtures <br /> A/C—Air Handling Units i ) <br /> Heat Pump i Toilet Backflow Preventer(inside Bldg) i <br /> Forced Air Systems • Unit Heater Bathtub Urinal i <br /> 1 Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain . <br /> ' Water Heater Refrigeration Shower Floor Drain I . <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 1 . <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/eta.) Other: <br /> i___ <br /> . :•SPRXNfL»R/ UPPRSSI ii.gsyATEivi • <br /> 'Number of Heads <br /> 3KNOWLEDGEMENT::Mato reviewed this application and confirm the Information contained herein Is true and correct.1%1/ork done pursuant to this permit must comply with <br /> rrent federal,state,and local law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized In writing from the <br /> Biding Official before being authorized under any circumstance.lam the owner,ori am authorized by the owner of this properly to perform the work for which application is made, <br /> d 1 comply with the State Contractors Law 18.2 BW nd 298.200A WAC. <br /> ! City ofEVerettOfficial Use Only <br /> // _ PERM? 1�j (19ner/Authorize Agent Signature Date (Revised 6/20/2010 <br />