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Jun, 9, 2017 10 : 55AM EVE*EEN STATE HEAT & AC • No, 9668 P. 1 <br /> PERMIT APPLICATION <br /> BUILDING/MBGHANICAL/PLUIVIBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 99201 <br /> (P)425-267-8810 FAX425-257-8857 I(E)evereiteps@averettwa.gov I ymmeverettwa.gov/permlfs <br /> (6'140'or Mack hik®nly,IPlease) RRgjEdT'taYE INFOkMAT1004 <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: O D <br /> LEGAL for new construction_ Short Platfsubdlvlslon Lot No. (attach copy of long legal descdptlon) <br /> .CONTAGT.INP'ORMkTIOhI <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STReEr <br /> CnY STATE 7Jp <br /> OWNER PHONE: 2 OWNER EMAIL: <br /> CONTRACTOR NAME: Cv�G�dlJ ST�TG G,(IE�yt���gL - <br /> CONTRACTOR ADDRESS,- <br /> Ctry e'1'ATe (,v 7IP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#/(REQUIRED): LV-P45 CITY OF EVERETT 8USINESS LICENSE#(REQUIRED)y.: U b <br /> PRIMARY CONTACT: ❑OWNER IaCONTRACTOR 6 OTHER^(Please Specify) <br /> CONTACT NAME; CONTACT PHONE: �25. ZS2•"���(� <br /> l I� C► ��lr / I lV�/ I CONTACT EMAIL; .eS ` � ti(71]y�/l - <br /> B(if 01NG Pt MIT APPLICA'1'(01�1 / ' <br /> Existing Use or Bullding: I Contract Price of Work: <br /> Proposed Use of Bullding: Tbas ❑Electric ❑Other <br /> Bulfdln T a: ❑SFR-Datached ❑SFR-Attached Muplex C1Multi4'amily-#of Uni(s: LlCommercial ❑Industrial <br /> Type of Project: EINew DAdditlon ❑Remodel ❑Re air ❑T.L ❑Sin ClSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> rtpLac:� <br /> ASSOCIATED BUILDINO PERMIT# if a lfcable: <br /> A77 <br /> 1..PEPLUMBING P� t llT APPLICATION`„ Addn Iteration Repair14-rollet <br /> Type or Project: Maty _Addn _Jllteration „_Repair <br /> tures #offist of Fixtures Lyse ofFiMures #°fLlsf of Fixtures <br /> Fixtures ling IIs Heat Pum I lBackflow Preventer(Inside Bldg) <br /> rced AfrS Rtarns Unit Heater jBalhtub Urinal <br /> as Piping 1130iler Lavatory(Wash Basin Drinking Fountain <br /> Water Healer R®frigeration Shower Floor Drain <br /> Gas Fireplace Wood Stovo 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/ete.) other: <br /> SPRINKLER/SYJ�IPPIYflff$�;10 Y sy:§TUM <br /> Number of Heads <br /> ACKNOWLEDGEMENT•I have reviewed this appflcatlon and confirm the loforwa(ton conlslned herein is tare and correct.Work done pursuant to lhls permit must oompd WIh <br /> current federal state,and to cal fate Tba granting ora permit only authonzes approved work and no doviallons therefrom,Deviations must first ba authorized In ivrnfng from the <br /> Bullding Official before being aulhoar®d under any clrcums(anca.I am the owner,orl am authorized byme owner of this property to perform the work rot which appllcatlon is made, <br /> and I compty w/th the Stsfe Contractors Law la27 RGW and 2sB.200A WAC <br /> CW of EverettOfflcial Use Only <br /> Owne AuthoTizad Agem Slanattirg Date <br /> (Revised 5r10l.2096) <br />