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• <br /> PERMIT AP.PLICATiON <br /> BUILDING I MECHANICAL,/PLUMBING 1 SIGN I SPRINKLER/DEMOLITION • <br /> _ CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)426-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits . <br /> ( or blat:k Ink®.;r tlt.> I® se) • .PR t•A1 6ji'SI(TE INF c 0I1610I01I . .. , <br /> PROJECT SITE ADDRESS: g73 f eel 19 (PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdlviston Lot No, (attach copy of tong legal description) <br /> .CON TACT iN 'ORM TI•AI . <br /> OWNER NAME: •9/2 Orr It, "a, TENANT NAME(If Commercial): , <br /> OWNER MAILING ADDRESS: STREET 373i <br /> CITY LVi4--12.e n STATE L4/v1 . ZIP ‘,g2,40 <br /> OWNER PHONE: ( •Z5) %5' 35?,9. OWNER EMAIL: <br /> CONTRACTOR NAME: EV5P.C'a AJ 67w-rd.- 0cir 4 4-o- <br /> CONTRACTOR ADDRESS: STREET °X(24) eA.c.„t pt. Au i <br /> ay '0V Ei STATE (fit,/.&-_ ZIP I 62120/ <br /> CONTRACTOR PHONE: 14°x-5•°-'2.-3/ICS • 'CONTRACTOR EMAIL: ke i-i,e.).e5'$fr+,Lp-At. anomie <br /> CONTRACTOR LICENSE#(REQUIRED): 1`1?6 S 11,220°l"• CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t56 r <br /> PRIMARY CONTACT: 0 OWNER 1:4,CONTRACTOR El OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: 4 75-` -5.2°,i19 <br /> k (34--e, CONTACT EMAIL: <br /> . . . ,. 1�UILDING P>Biit(di11P APPL1CAT1ON • • , <br /> Existing Use of Building: 1 Contract Price of Work:$ l� O <br /> Proposed Use of Building: IHeaf Source: C(Gas iecfric 00ther <br /> p g <br /> Building Type: CISFR Detached CISFR Attached ODuplex QMuft[Family#of Units: [[ommercial Dlndusfrial <br /> Type of Project: QNew IjAdditlon ElRemodel gRepalr UT.I. EiSign ElSprinkier ClDemolition ClChange of Use <br /> DESCRIPTION OF WORK: g (ALta- '�t, 00I2 6'(y(1 . L d 0 Gua cr k,t,,e,A 0.,,�z,, <br /> ASSOCIATED BUILDING PERMIT Cif applicable: — <br /> _ .IItIECI4IA HoiL,PER.MIT.APPLICATYON'iP UM IMS l Rfi I1l"APPLICATION <br /> Type of Project: _,New Addn • _Alteration_Repair j Type of Project: _New Addn _Alteration _Repair <br /> #of List Fixtures #°f List of Fixtures #°f ' of Lfst of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC—Air Handling Units Heat Pump <br /> Forced Air Systems <br /> Gas Piping <br /> Toilet <br /> Backflow Preventer(inside Bldg) <br /> Unit Heater Urinal <br /> Boiler Drinking Fountain <br /> Wafer Heater <br /> Gas Fireplace <br /> Refrigeration Floor Drain <br /> Wood StoveDisposal <br /> Grease Trap <br /> Gas Range Ducting Roof Drains <br /> Clothes Dryer Hookups Other: Medical Gas <br /> Range Hood Other: <br /> Exhaust Fan •• Other: <br /> S0.MiSiXLf R/SUPPR S,SIO,Y SYSTEM <br /> [Number of Heads <br /> 'CKNOWLEDGEMENT: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 /> •urrent federal,state,and local/atv.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> wilding Official before being authorized under any circumstance,I am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> nd I comply with the State Contractors Law 18.27RCW and 29B.200A WAC. <br /> C1ty of Everett Official Use Only <br /> w"tJ <br /> r; 3(41 PERIM 1 goc ®®- <br /> caner/Authorize Agent Signature Date (Revise 6/20/2 16) <br />