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PERMIT APPLICATIdN <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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS:4204 COII��/AV2 PROPERTY TAX#: 00582202100703 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: Richard & Donna Adler TeNaNr Nanne�it commerciaq: Adler-Giersch <br /> OWNER MAILING ADDRESS: srReeT 333 Taylor Ave N <br /> o,n Seattle srnrE WA ziP 98109 <br /> OWNER PHONE: 206-682-0300. OWNER EMAIL: <br /> CONTRACTOR NAME: Universal Mechanical Service <br /> CONTRACTOR ADDRESS: STREET PO Box 2649 <br /> c�rr Redmond sra,rE WA z,P 98073 <br /> CONTRACTOR PHONE: 425-885-9100 CONTRACTOR EMAIL: heath unimec.com <br /> CONTRACTOR LICENSE#(REQUIRED): UNIVEMS'I32.IF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O2�363 <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-885-9100 � <br /> H@atll HUtCII@IlS CONTACT EMAIL: heath@unimec.com <br /> Existin Use of Buildin : p��_ Contract Price of Work:$ 7�� <br /> Pro osed Use of Buildin : Heat Source: ❑Gas Electric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex OMulti-Famil �of Units: ommercial �Industrial <br /> T e of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF ORK: <br /> /,r/37's� O.fi�?7�9�Fi� S�L/T I��►�i,.�c P =�-r+�+. <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> ' ' " £ �.,. ' , : : ' _ <br /> Type of Project: _New_ Addn �Alteratlon _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Ust of Flxtures #of L/st of Flxtures #of ��st of Fixtures #of List of Fiutures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 1 A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Ran e t Ductin Dishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BaNMo /etc.) Other: <br /> � � � � Number of Heads � ��� � � � � <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true 8nd correck Work done pursuant to this permit must comp/y with <br /> current federal,state,and/ocal law. The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must�rst be authorized in writing from the <br /> Building Ofiicia/before being a horized under any circumstance.I am the owner or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and/comp/y with the tat ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officla/Use Onty <br /> / � PERMIT# I —} � <br /> Owne uthorized Agent Signature ate (Revised 9/23/2016) <br />