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PERMIT APPLICATIO <br /> .,..4v::.:'_ BUIL.®I I MECHANICAL I PLUMBING /SIG�RINKL ER I DEMOLITION <br /> CITY OF EVERE I I PERMIT SERVILI_S <br /> '`-r 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I vvww.everettwe.gov/permits <br /> .-..., ._.4__� - ---... _.•. ..... .... . . ... :!. ... R0.7ECT_SITE-INI.SRM,ATION"':;!;:F°i:97M::..:0 _ :Z4:::'_. <br /> PROJECT SITE ADDRESS: RL j o - �`hQ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> r� IdTA0T;'INI=;ORMAThON`., :`" °; ...:. ::;::: :. ': - : <br /> -,:- . : :; <br /> : --. • . . •. <br /> OWNER NAME: F OI1O-y1d,2{ Jj ve5 irvtOM ir3 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRttl mg. ./t/ Grvty/fL 4 C.8'I S-F F. S vj 1L2 L GS/� p <br /> CITY f e/( ;06,0\ STATE IA,-l-i . zIP ''C/ 22,5 <br /> OWNER PHONE: (S60) 2% ! ZSS OWNER EMAIL: •��y 1al(cJIctaf- i f1 Ve s i,Ka.n IS,C.-0,,-.. <br /> CONTRACTOR NAME: Hat a 12cki-r j-h ves-I Yl4.i}1-ts <br /> CONTRACTOR ADDRESS: STREET <br /> Cm, STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER O CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '. .6 D 2-97_ I Z 5 c <br /> -CP/( - CONTACT EMAIL: f-t p(( d6kr- I i V.•-ft rt 4.C-0171 <br /> .. . :-.... LDIN+�=PERNiIi"�\PPLICATION ::`��;'. :: ';;, :;,;.,°:•;-.:-. <br /> z <br /> Existing Use of Building: 1'4 0Contract Price of Work:$ I.cO0 <br /> ��1 <br /> Proposed Use of Building: Hotel Heat Source: E Gas frgElectric ❑Other <br /> Building Type: ❑SFR-Detached I:SFR-Attached ODuplex ❑Multi-Family#of Units: ['Commercial El Industrial <br /> Type of Project: DNew OAddition DRemodel IDRepair 411. EISign OSprinkler CI Demolition ['Change of Use <br /> DESCRIPTION OF WORK: n Q c kuo 1444( Pan n ¢t- ç ; o V s0 L, .4 <br /> n54eru�! con-e,r x,1( 6e net, p.e4_ Ii <br /> 1nc. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • : . :00M10.II G-PE_RMIT-APPLIFCATIiON. <br /> '.•� > •:°"MECHANICAL:.FERMIT=APALIGQTION;;_..:.::..;: - <br /> Type of Project: New_ Addn __Alteration _—Repair Type of Project: _New Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures <br /> List of Fixtures #of List of Fixtures #of <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump 1/ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 4f Bathtub -• Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration _ 9 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 /> :. , ;••.;SP:RINKLER I SUPP,RESSION`;SYSTEM=`__ <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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,or!am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> PERMIT# <br /> �I ?.- i _FJ ......, <br /> ((oo - 00D\ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />