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0 0 <br /> ,IIIP PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN 1 SPRINKLER/DEMOLITION • <br /> ' CV OF EVERETT PERMIT SERVICES <br /> -'r 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425 257-8810 I FAX 425-257-8857 I(E)everetteps@evereftwa.gov I Wwweverettwa.gov/permits . <br /> 011.4 11:'hrai k Belk i11.13-Pt® s®) • i R`tJJECTSgTt INFO, i irifo), . . ' <br /> PROJECT SITE ADDRESS: /9l47 ,4i'/ _> $G -2_49j !PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> i .CO ITA©Y:iNEO kWATio . ' • • • . <br /> OWNER NAME: / j 11*m 6UCbI ry 1 [/ ArTEE�NANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET tot 2i•J - / 'Il / t3 ov y� �( <br /> C}TY � i STATE • ZIP %�l 6 <br /> ,OWNER PHONE(LIV :78c--g,I30 .._..„�__m IOWNER EMAIL:.. ,, ................ .. e,.,..,,ro ... mr..,u.,... <br /> CONTRACTOR NAME: E U .(a 5AJ 6`l`LhTIf 4-(6- 04, <br /> CONTRACTOR ADDRESS: STREET °2 I`ram- f i Pt. AU g" p� <br /> CITY 'TY () STATE (,414-- ZIP p S2-0/ <br /> CONTRACTOR PHONE: 14 S•5.-2.5 1-3/It-1 • CONTRACTOR EMAIL: ! <br /> CONTRACTOR LICENSE#(REQUIRED): CUQYL4 jS 0 .2.0 r CITY OF EVERETT BUSINESS LICENSENREQUIRED): t.6/q,5'5' '' <br /> PRIMARY CONTACT: ❑OWNER r&CONTRACTOR El OTHER(Please Specify) • <br /> CONTACT NAME CONTACT PHONE: 4' 5 °..2-5 2- 1/! <br /> :7C-� -/ CONTACT EMAIL: lode". 0..c S GLl W rp,1.-, ai tvi <br /> . .. b1)ll.tiIAt(3- Rli/llTAPPti[dA'>i'tofd' • ' • . • • • • <br /> Existing Use of Building: i Contract Price of Work:$ i , <br /> Proposed Use of Building: Heat Source: °Gas °Electric ❑Other <br /> Building Type: CISFR Detached OSFR-Attached °Duplex C1Multi-Family-#of Units: Commercial Cilndustrfal <br /> Type of Project: °New ❑Addition °Remodel pair CIT.!. ❑Sign ❑Sprinkler °Demolition °Change of Use <br /> DESCRIPTION OF WORK: e,_ ,, ., NZZii 144,0,4.• 't z!} . <br /> ASSOCIATED BUILDING PERMIT##(if applicable): <br /> .110CIAN/CAL,O/ d[1/HT 00PL IICATliOf . • . PLUIV1611416 Pagtia IT APPLL!CATIi GN : <br /> Type of Project: New Addn _Alteration_Repair#of <br /> Type of Project: _New Addn Alteration __Repair <br /> Fixtures List of Fixtures I <br /> of <br /> Forced Air Systems I <br /> Fixtures List of Fixtures Figures List of Fixtures Fl u <br /> B List of Fixtures <br /> NC—Air Handling Units Heat Pump i Toilet • Backftow Preventer(Inside Bldg) <br /> Unit Heater Bathtub Urinal <br /> Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Heater Refrigeration 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 I <br /> Range Hood / knitWafer Heater Other: <br /> Exhaust Fan <br /> 0 Sink(Service/Bar/Mop/etc.) Other: <br /> 'Number of Heads <br /> CKNOWLEDGEMENT:/have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> orient 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 /> uiiding Official before being authorized under any circumstance;/am the owner,off am authorized by the owner of this property to perform the work for which application Is made, <br /> id I comply with the State nfractors Law 1a27RCWa 296.200A WAC. <br /> City of Everett Official Use Only <br /> s I fl()PERM! q01— OgO <br /> vner/Authhazed Agent Signature Date (Revised 6/20/2016) <br /> 1 <br />