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477PERMIT APPLICATION■ ORIGINAL <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 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> lj4z,ma-- 1 'f ,b'?�,i W z�lai,r -., �"r "�"S+H'r sae9 k €' m TM.,6 m= av age �f v <br /> ; - . P,k _. �e ;'� _ 1 R-0EC tTE lkF0WIMA: rON - _ , : <br /> PROJECT SITE ADDRESS: 552-1 15ir ( ) PROPERTY TAX#:006/1-1000003�/) <br /> LEGAL for new construction: Short Plat/subdivision / 91 �/t Lot No. (attach copy oflong legal description)(( <br /> l 4r0103 <br /> lw tl qimoCON07CTINFORMATION Gsz' rzg rmm ,MI <br /> OWNER NAME: Haa... ilit J(tib TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5-5'/ 14.I/') .Q, U, <br /> CITY b. Cril/� STATE J4 ZIP pz,:z5 <br /> OWNER PHONE:/1"i4~ 0 29 OWNER EMAIL: rK4 ryrtI ,(Orr) <br /> CONTRACTOR NAME: 3 0.e. F I eU ► EL- <br /> CONTRACTOR ADDRESS: STREET 7l l(2 -2,7,6441 31 S(i) 1 <br /> CITY H T STATE((I+ ZIP %1/!7y '/� <br /> P� <br /> CONTRACTOR PHONE: l''7/D _1-1 - 1 q CONTRACTOR EMAIL: 111'--G 17/019V/MeeM17-11)/r/eaTCONTRACTOR LICENSE#(REQUIRED): LU 83. t16. CITY OF EVERET BBUSINESS LICENSE#(REQU ( <br /> IIRED): ) <br /> PRIMARY CONTACT: 0 OWNER t% ONTRACTOR 0 OTHER(Please Specify) <br /> C NTACT NAME: i I CONTACT PHONE: *0— -- <br /> lf\ <br /> nnC) " �Y .e) CONTACT EMAIL:1i ti�.=c.e) ' <br /> i .f <br /> an <br /> 6' I . ! 3m1M IRINC0. VAP- lOm011 . 1n72t2310•14 <br /> Existing Use of BuildingContract Price of <br /> Work:$ 146 3V <br /> Proposed Use of Building: Heat Source: littas ❑Electric ❑Other <br /> Building Type: '. SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ARepair ❑T.I. El Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> \ \Le (Alia Ymci CV7art_ ave: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 4,F.''''',-MECHANI,CAL'PERMIT A*PLICATIO.NraV ZONEWATSIUMBISWOORMitAPP04ATION1/" ',,:1_ ;- <br /> Type of Project: _New _ Addn _Alteration,'Repair Type of Project: _New Addn _Alteration _Repair <br /> °f List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> IForced Air Systems Unit Heater Bathtub Urinal <br /> i Gas Piping Boiler Lavatory Mash 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 /> At 10NKLER` ;SUPPRES,SION SYSTEM K <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contr-ctors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> yi1a [ ii <br /> PE T# C ,_00 5 <br /> O r/A o d ge ign- u - Date (Revised 10/12/2015) <br />