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425-252-1666 c.m. heating 12:51:59 12-11-2015 2/3 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8910 FAX 425-257-8857 1(E)everettepsgeveretilwa.gov I www.everettwa.gov/permits <br /> CT-SITE'INFORMATIO <br /> PROJECT SITE ADDRESS. _ PROPERTY TAX#: <br /> 7,d <br /> LEGAL for new construction: Short Rat/subdIvIsion Lot No. (attach copy of tong legal description) <br /> i i7 i-:11 M� <br /> 14 F dkm Ati 6 <br /> OWNER NAME: 1 1 11 tieV41- I S o V) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STRErT GLI 2N L-owieij Rd 5-e, <br /> cn-Y p-el STATE WA ZIP 9'32-o3 <br /> OWNER PHONE: Ll 25 - 3i55-OSIS OWNER EMAIL: <br /> CONTRACTOR NAME: W Htahige Inc, <br /> CONTRACTOR AID DRESS: STRFff j iw5- 3ro4lmaiii <br /> CRY eNt6rj — 4 STATE WA C102-01 <br /> CONTRACTOR PHONE: Li?-5 2S9 (00(aG [CONTRACTOR EMAIL-debipie, com <br /> CONTRACTOR LICENSE#(REQUIRED): CrAQEA1:*0q157RL4 ICITY OF EVERETT BUSINESS LICENSE#(REQU1'RoED): 0 1(p t)qo <br /> PRIMARY CONTACT: El OWNER XCONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �25 25q (06(v& <br /> Ot ue r's CONTACT EMAIL: d e We & cm ie ortf'kq!s (a iii <br /> V, <br /> 5KIIN <br /> Existing Use of Building: Contract Price of Work:$ q1 ?&, 143 <br /> Proposed Use of Building: Heat Source: YGas 0Electric 00ther <br /> BuitclingiType: EISFR-Detached XSFR-Attached E]Duplex 0MuItj-Farn1Iy-#of Units: ElCornmercial ElIndustrial <br /> Typeol'Project: 0New ElAddition emodel EJRepair LIT.11. ElS(gn ElSiorinkler ElDernolition ElChangeol'Use <br /> DESCRIPTION OF WORK: <br /> F-q?)@C'e <br /> -ASSOCIATED BUILDING PERMIT# if applicable): <br /> Ilk <br /> VA0i0ficAti6f4'.;,'77 <br /> Typool'Project: _Now _ Addn >(Alteration —Repair Typo ol'Project: _Now ­Acidn —Altoratlan —Repair <br /> #of LJst of Fixtures Fixtures Fixtures Fixtures#of Llst of Fixtures #of Llst of Fixtures #of List of Fixtures <br /> Fixtures A/C-Air Handling Units Heat Pump 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 I 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 /> ':-Z KLERI`SUPPRESSION SYSTEM`.. ;'- <br /> Numberr of Heads <br /> ACKNOWLEDGEMENT.,I have reviawod lhTs upplicallan and confirm the Inform allon contained h are In Is true and correct Work done pursuant to th Is penn1l must campy with <br /> current federal,sta to,and local law.The gran ling of a parmll only authorizes appro vud work and no da via lions therefrom.Do via flons must f7rsl be authorized In writing from the <br /> B uIlding C fficlal before be/ng a u lh adze d under any c1rcumstan ce.I am Ilia own or,ori am a uth orizad by th a owner of this property to perform the work for which applica lion is made, <br /> and I comply with th a State Contractors Law 113.2 7,F?C IN a n d 296.200A WAC. <br /> Cl1yo(LverellOfficlalUsa Only <br /> PER 'IT# <br /> ou 11A/ <br /> (D�vnor/Authorlzod A Signature Date fRovisled 1b/12/2015) <br />