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PERMIT APPLICATION • <br /> 'L.-20` <br /> ../. • <br /> BUILDING/ MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 l(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> . .., .PRO0.ECT.:ShTE.IMF_ORM :- .:..:.. .... <br /> � . ... <br /> .. .. . .. . . ..l.:: .:......g .:: <br /> PROJECT SITE ADDRESS: +111 ,17 4.4' ,04,....1-- <br /> 0c'� , PROPERTY TAX#: Cz3b 2,� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) a <br /> ..._,. . .__:..:.. : .CONTAG4`i';:1NIF`OI2MATION_>< :'°g..: . :';:.;.;`::•::',1: ':..;..•.::' - <br /> OWNER NAME: A App 1�QE-(2.6Qi AVOrMeriSTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '12Z) La.,ki!N(,"reA pe.i 5-cE 2e-I A t 1 ./.« <br /> STATE / .1 y ZIP 10+ i `4 <br /> OWNER PHONE: .2.04,- 9'IO- I b5S- OWNER EMAIL: j.WeLfISe.CAIi bmitavvroacju'vieA •(.r41 <br /> CONTRACTOR NAME: G14 Nee- <br /> CONTRACTOR <br /> ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: Ind OWNER 0 CONTRACTOR :j OTHER(Please Specify) 2i' P`z t' •M4.11/MIC T <br /> CONTACT NAME: CONTACT PHONE: 20(0-- `)'p--f(a,•$'' <br /> cSg r v4GC;1js CONTACT EMAIL: ,,loj c.‘s@Lal',bZ.-i0afant j.2.....014 :E oil <br /> _ ;_ -::_: :,; -_: A T _-_- ,V.:._ _ .:..::':: :_:. <br /> ._�__,_:.�--_-.:__- =_,„-_�:__- -:-::.- -_<: BU:ILDINO.P.,ERMIT.APPLICA :L -.. ...._. . . <br /> Existing Use of Building: 15 7 ,V Lfl1 PE— F-44_ NLy /C I Contract Price of Work:$ <br /> Proposed Use of Building: `QE- Heat Source: OGas (,electric ❑Other <br /> Building Type: DSFR-Detached OSFR-Attached ODuplex , Multi-Family-#of Units: / DCommerciel El Industrial <br /> • <br /> Type of Project: ONew RIAddition DRemodel DRepair DT.I. OSign DSprinkler CDDemolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> ADDr'n4-U L LAN (,LI Vli\AG Dox-z-1-0\),e) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT=APPLICATIION:_: - :P.LUMBINC.PSR •:AP OMIITAPPLICATION <br /> Type of Project: _New^ Addn _Alteration _Repair Type of Project: New Addn ^Alteration Repair <br /> #of #of #ofList of Fixtures #of List of Fixtures <br /> List of Fixtures List of Fixtures Fixtures Fixtures <br /> Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water 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 <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> , :.: .:SPRINKLER/SUPPRES:SI.ON`SYSTEM :: <br /> Yds feo,dvAetJ 'Number of Heads Ante uNn' <br /> ACKNOWLEDGEMENT:1 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.I am the owner,or I am authorized by the owner of this properly 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# <br /> ?/7//� <br /> 0 ,ner/Au -ori -d Age W-ture Date (Revised 10/12/2015) <br /> i3IX07-- 643 t <br />