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• • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL!PLUMBING I SIGN l SPRINKLER I DEMOLITION • <br /> 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.gov/permIfs , <br /> ( l i®•crr k1sa(teak®.niyf,Pleose) ' - fP11QJJECT SITE II'+ifF®,' [U11 1i IOi! ..• <br /> .. . <br /> PROJECT SITE ADDRESS: 35i.rj aI( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. • (attach copy of long legal description) <br /> f,_ ' _ .CONTACT,IiimOORMA I®NII . . . • . ...• •••_ • <br /> . <br /> OWNER NAME: 10(()A ' TENANT NAME(If Commercial): <br /> OWNER MAiLING ADDRESS: STREET (3SZS do 1 kJ A,Es-. / �j(j . <br /> I CITY L�tikaZi�- t`STAATE ta\„ ZIP C r Zc� I <br /> !OWNER PHONE: N s) z z ci .L...._ .,.....m..- 'OWNER EMAIL:.... /v/".:,...,...ti. <br /> • <br /> CONTRACTOR NAME C U iz. A_<) 6rt-Tit i4c. I/t26`A'f- <br /> CONTRACTOR ADDRESS: STREET '2-I 2-Sb ( CA cit. A()gr <br /> ITT S U 2 6 t STATE (it!4- ZIP 61 e32-0/ <br /> CONTRACTOR PHONE: 4,2-5,-2.5- .-5//l • !CONTRACTOR EMAIL: Xe.A t2. S,SM Q•, 440 - <br /> CONTRACTORL[CENSE#(REQUIRED): E-Uar2,66S02Zv.T- ICITYOF EVERETT BUSINESS LICENSE#(REQUIRED): 4.961el,-5' <br /> PRIMARY CONTACT: 0 OWNER I$ ONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: 4. 5 s 2- -" l9 <br /> /4 Yel Lc) CONTACT EMAIL: <br /> ,: .• ,. b IL6II0-.001-1T AOP.L. dA'i';Y®l' . . . . •• • <br /> Existing Use of Building: i Contract Price of Work:$ dQO, <br /> Proposed Use of Building: Heat Source: ❑Gas DElectrfc ❑Other <br /> Building Type: CISFR-Detached OSFR-Attached CODuptex :Multi-Family-/#of Units: Wommercfal Cllndustrfal <br /> Type of Project: ONew ClAdditlon ElRemodel URepalr CIT.I. E75ign I:Sprinkler DDemolit!on ClChange of Use <br /> J <br /> IV1ECHANNNICAL, Rnl1l`>i APPLICATION 1pl�lAlVlt I44T�1�� 11/td 'A�1�LI1CA�I®J ; <br /> Type of Project: New Addn Alteration__Repair Type of Project:_New Addn Alteration `Repair <br /> Fixtures List of Fixtures I FixturesList Fixtures ' Fixtures List of Fixtures Fleur s ListofFixtures • <br /> 1 A/C—Air Handling Unitsof Heat Puof mp i Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller 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 /> . .'S INr'LEI)SUI0PRESm0M SYSTEM <br /> Number of Heads <br /> CKNOWLEDGEMENT:Maya reviewed this application and confirm the information contained herein Is true and correct.Work done pursuant to this permltmust comply with <br /> urrent 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 /> lidding 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 /> Td!comply with the State C tractors Law 18.27RCW and 296.200A WAC. <br /> Ciy of Everett Official Use Only <br /> t �, _ 11 1 PER(.. - "-) Tywitn- io <br /> vner/Authorized gent Signature Date (Revised5/220/2018) . <br />