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BUILDIM6ECHANICALPERMIT I PLUMBING I SIGAPPLICATIONTURINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: 410&f D6,,J1,ny1bPt L4rg <br /> IPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat(subdivision_Lot No. (attach copy of long legal description) <br /> 5—. <br /> OWNER NAME: 13 Ly Geni TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS- STREETli^A-kY� <br /> My 8ve-1--4 STATE i-VA zip <br /> OWNER PHONE:ttzs— OWNER EMAIL: 0!h�118 3C 0- covicAJ-4. ii-o-+, <br /> CONTRACTOR NAME: Silha4l�e -S:XS-4*1t7 -THC— <br /> CONTRACTOR ADDRESS: STREET 'VS YC Le,0±g t\/!w W <br /> ZIP 7 8/0 -7Z <br /> crry Ste, STATE kV14 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 5(4►1 e4-s 1 D D4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0SIS7Y <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME, CONTACT PHONE: <br /> ICONTACT EMAIL: j6h K-mr%,P—Jy,'5'S-f nu Cam <br /> l <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: '—C Heat Source: ElGas OElectric E]Other_ <br /> Building Type: EISFR-Detached EISFR-Attached ODuplex 0Multi-Family-#of Units: OCornmercial F-11ndustrial <br /> Type of Project. ONew 0Addition EIRemodel DIRepair E1TI. OSign OSprinkler ElDernolifion ElChange of Use <br /> DESCRIPTION OF WORK: 6'600 we,-ffi- 4 C a1-ff"\+ <br /> 'k r1?elal"Q'I <br /> orfivi4a<-,Hve, 90A 6&,dc-(P� 6vtoLkw 1-1\ 2-C>0'4 M'11h 6 -/0`4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 0 ........... <br /> Type of Project: ___Now Addn _Repair Type of Project: __--New __Addn _Repair <br /> #of #of #of List Of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(inside <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas PipingBoiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater_ Refrigeration IShower 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 (Service/Bar/Mop/etc.) Other: <br /> W A.FIR P ESSIO <br /> OK , <br /> INumber of Heads a is is permit must comply with <br /> ACKNOWLEDGEMENT.•i have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to th p <br /> current federal,state,and locallaw.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 I am authorized by the owner of this property 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. City of Everett Official Use Only <br /> PERMIT Owner Authorize Agent 0/�q <br /> :gnature Date (Revised 1011212015) <br />