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0 0 <br /> PERIiMIIT APPLICATION <br /> BUILDING 1 MECHANICAL I PLUMBING 1 SIGN i SPRINKLER/DEMOLITION • <br /> T CITY OF EVERETT PERMIT SERVICES <br /> • - 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govipermits , <br /> (1§ txe.or stack Ink®.nIy lease) - • • PROJECT�1 E 1NFORNIATIO I •- .,,// • <br /> PROJECT SiTE ADDRESS: -269/ e e, )PROPERTY TAX 4: O©739/j '2DO/DC) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ..coRtiker.IMF®RMAT i Id <br /> OWNER NAME: 6' O7 OAf 1-i*//l //�✓/>' TENANT NAME(If Commercial): sL /fv �1. <br /> OWNER MAILING ADDRESS: STREET2g, ( D • <br /> ' CITY 47 STATE AM— ZIP g• y <br /> OWNER PHONE: /JAt)& 6 OWNER EMAIL: Pegit eaStee�/�s{•Z ,C-� <br /> CONTRACTOR NAME: E U-ld_.6MIrJ 6 L TA-Ter C `` 6 A2GA-c.. <br /> CONTRACTOR ADDRESS: STREET � //, <br /> `-0 C <br /> 1 hi fit. AU l <br /> • <br /> coy S UC STATE (,v A____ ZIP 6/G20( <br /> CONTRACTOR PHONE: 4`2-5,2.c 1-'51/I ci • CONTRACTOR EMAIL: MAItk,0' %/n uA , <br /> CONTRACTOR LICENSE#(REQUIRED): E(J js case)'f• 'CITY of EVERETT BUSINESS LICENSE#(REQUIRED): Q.)6q q 5-5- '• <br /> PRIMARY CONTACT: ❑OWNER RCONTRACTOR CI OTHER(Please Specify) <br /> CONTACT NAME:n CONTACT PHONE: 4 7 5-a.2..5-Z- ,i/9 <br /> /v1 AA Nu_ CONTACT EMAIL: mAdt. Q C,%v 60- <br /> • <br /> Existing Use of Building: jtZptjrTlNfi i Contract Price of Work: �;� ' <br /> 1✓ <br /> Pro posed Use of Building: G' ' (nd Heat Source: }Gas C1Electric QOther <br /> I <br /> p 9 <br /> Building Type: ❑SFR Detached ❑SFR Attached ❑Duplex QMulti Family of Units: Commercial Dlndustrial <br /> Type of Project: ❑New DAddition URemodel ErRepair EIT.I. E(Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: TLon0Uc . kipk t , lid rex 1,44,,e ,7•1fs <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> : :iv:iEbi=1.AkgcAi..0klingT APPLicAu I®i4 I . • • . . iPLUMVIRINO OEI I1filt APPLicATII1 f • <br /> Type of Project: _New Addn Alteration 4 Repair 1 Type of Project: New Addn Alteration Repair <br /> #of List of Fixtures I #of List of Fixtures '15of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures i Fixtures ' Fixtures <br /> A/C—Air Handling Units 3 Heat Pump I Toilet IBackflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater i Bathtub 1 Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower —Fioor Drain , <br /> Gas Fireplace 7 Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains • <br /> • <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> • <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.), Other: <br /> ! 'Number of Heads <br /> ACKNOWLEDGEMENT:/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.lam the owner,or am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18,27RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> (--NCIQ <br /> CI! I PERMIT 1 M 0fo 1 <br /> n)caner/Aufhoze of Signature Date <br /> \ <br /> e (Revised 5/20/2016) • <br /> I/- <br />