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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL 1 PLUMBING/SIGN I SPRINKLER I DEMOLITION • <br /> ' CITY OF EVERETT PERMIT SERVICES <br /> '_r 3200 CEDAR STREET,EVERETT,WA 38201 <br /> (P)426-257-8810 i FAX425-257-8857 1(E)everefteps@everettwa.gov I Www.everettwa.govlpermits . <br /> (W •®t'bratik 1tI:k on(i{.1ptease) • • PPRQJECT SIMS 1NPON1idlie 1 .. • . <br /> PROJECT SiTE ADDRESS: 5'300 (cat exi(-a©c:j!3 4( L ,4—1 PROPERTY TAX#: 1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) <br /> • CONTACT 191 ®R1i1M `,If g®t17 . <br /> •'OWNER NAME: MAR tt1 tit. 1a L- .— / /►f-lVTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET _54-Le t) I- 4oLy Nle YZI <br /> ` CITY r 1 / STATE 10 g. ZIP .• ' <br /> I OWNER PHONE: OWNER EMAIL: (L it.�q �yyl r rd,s vi.. j �0-r,.� <br /> CONTRACTOR NAME:p»T'�Uta.�ucC Uv._.,..'`�7�Tf( t rcrpt `d1-c-..,.,.,,.,..».. .�,..� /�.+_. ... ., ...., »�.. ,._.� <br /> CONTRACTOR ADDRESS: swear '2-f'2,0 PA-c-1 fit- er � <br /> CITY S 1/Ems STATE (/`//k q y'7 <br /> ZIP p <br /> CONTRACTOR PHONE: g°2-5,12-57./5// • CONTRACTOR EMAiL: .t• &-j S'1144-42.Caw.— ' <br /> CONTRACTOR LICENSE#(REQUIRED): EO}R jS&2 .0'i" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4.9 b r 5- - <br /> PRIMARY <br /> PRIMARY CONTACT: FEI OWNER IONTRACTOR Q OTHER(Please Specify) f/_..»,y, <br /> CONTACT NAME: CONTACT PHONE: i47+�' -7s'2d"/f rye' <br /> CONTACT EMAIL: <br /> - __ <br /> . .. ,. 1311 ,1 1NG OliirtirrAPP,LJCA` itOH ' ' . . • <br /> Existing Use of Building: i Contract Price of Work:$ S ©©1 <br /> Proposed Use of Building: (Heat Source: ' as EtElecfrlc ElOther <br /> Building Type: QSFR Detached OSFR-Attached Xiiiplex C(Mulfi-Family4 of Units: ❑Commercial ClIndusfrlal <br /> Type of Project: QNew QAdditlon E7Remodel f tepalr QT.i, QSign QSprinkler QDemolitlon ElChange of Use <br /> DESCRIPTION OF WORK: <br /> KepiA-G5 ERISTf 6,45 1-%u2 Ceo /'• lam <br /> ASSOCIATED BUILDING PERMIT#(ifapplicable): <br /> .1V1 c1-IdAl 1CA1, i k1Vi1'1'APPL1G � f1 . ' . IPLUM�imat PEg1 1TJ PPLICAT11s • <br /> Type of Project: _ _New Addn+ Alteration J�Repair I Type of Project: New Addn Alteration Repair <br /> #of List of Fixtures r #of List of Fixtures I #°f List of Fixtures #of List of Fixtures �+ <br /> Fixtures 9999 Fixtures ;Fixtures Fixtures <br /> A/C—Air Handling Units ! Heat Pump i Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler i Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain • <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> I 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 /> : :*&itiffigfLER7 0.019REp ®1't1 Sl YSTE MU:l <br /> TNumber of Heads <br /> .CKNOWLEDGEMENT.•l 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 law.The granting ofa permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> ui/ding Offic/al before being authorized under any circumstance.I am the owner,on am authorized by the owner of this property to perform the work for which application is made, <br /> lc i comply with the State Contractors La .27RCWand 296.200A WAC. <br /> City of Everett Official Use Only <br /> /..1.--- -...-- PERMIT. �: I <br /> 01 — <br /> P/ , <br /> o <br /> vner/Authorized Agent Signature Date (Revised /2018) • <br />