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at ..#0.4177. PERMIT APPLICATION <br /> BUILDING -CHANICAL/ PLUMBING / SIGN /1 -INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICE <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 /> (Blue,,or Blacl Ifk blly=Ple €"se). '../, z< F RO4g.C' ,SITE�MFO M/#T1QN, . .,„.. s .E <br /> PROJECT SITE ADDRESS: ///20 f t/� ett/ WAY *.p PROPERTY TAX#: D d q Zgo03ra 700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> tib Ii CoNitA INF'ORWATION k r <br /> ;._ „ '7;;':::: ,:04.::::.. ......,.Yds aS3�_ Wa�,_�... . ... ..,. „ <br /> OWNER NAME: ab 1 )Ar) Loper/AJ 7 LLC TENANT NAME(If Commercial): ft 1 L_(40-LA /NC <br /> OWNER MAILING ADDRESS: STREET yf18 t 2-3 1-/Wy 9,q e2 o.S �� / p� y <br /> f/ 11 ciTry�j l-WV '/Bii®O1> STATE liV A ZIP `9gfl 3 / <br /> OWNER PHONE: l �6) q 4! !!!6 3 e 7. OWNER EMAIL: <br /> CONTRACTOR NAME: 12 /A11L A-hVAIJC.1> CoV_<7� J/ ,fl od CO <br /> CONTRACTOR ADDRESS: STREET /0 , /� <br /> 0� 9 9 -t4,4, A� i , <br /> CITY �1)/. 1`0a b s \ STATE WA' ZIP 4..(f) ii./ ' <br /> CONTRACTOR PHONE: 02-S) 7 7) - /`9_ /�3 <br /> CONTRACTOR EMAIL: 1vI,) 7fi 2ig-A/DY7 -'r s APA:4 <br /> CONTRACTOR LICENSE#(REQUIRED) C C.7 4 C 8? . .9,- CITY OF EVERETT BUSINESS LICENSE#(REQUIR=D): Cr <br /> PRIMARY CONTACT: 0 OWNER 14 CONTRACTOR 0 OTHER(Please Specify) *a , <-►'1 <br /> —�m. <br /> CONTACT NAME: _ CONTACT PHONE: 1/ 9 2_ A )A-Npy -r- kt �. <br /> CONTACT EMAIL: 4) i›y7v/ f}i/PY }, k. <br /> .. .. . .. ...;., 7 _ ., BUJLb,1NCaotPBRMJ "APPLICATION v.,:T.v r, :; W. . <br /> Existing Use of Building: " f • Contract Price of Work: ✓r/' <br /> Proposed Use of Building: 441%16 Heat Source: ❑Gas DElectric Dot er <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: %Co ercial ❑Industrial <br /> Type of Project: ❑New ❑Addition XRemodel ❑Repair DTA. DSign ❑Sprinkler ❑i- _: ' ❑Change of Use <br /> DESCRIPTION OF WORK: ceiv ' 'Rt'G- 'iiT /Rio, Nod—Jz4)/Aler (AJAL.�. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> PLUMBING PER.- MECHANICAL,PERMIT�APP�.ICATION �.. �IITAPP#.ICATION ‘-'- <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of'ixtures #of List of Fixtures #of List o7 ixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling i nits Hea 'ump Toilet Backflow P -venter(Inside Bldg) <br /> Forced Air Systems it Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Dr- Ing Fountain <br /> Water Heater Refrigeration Shower loor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hooku.: Other: Clothes Washer edical Gas <br /> Range Hoodx-' Water Heater a her: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER',/,SUPPRESS10N SYSTEM: <br /> Chemical or Water I No.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 I am authorized by the owner of this property 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. <br /> /� p 4 ...... 0, 9 <br /> 0 <br /> City of Everett Official Use Only <br /> PERS# <br /> / ??...„--4, otf-,/s-2-0/7 <br /> Owner/Authorized Age Signature Date (Revised 9/23/2001i'6))J� <br />