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PERMIT APPLICATION <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.everetiwa.gov/permits <br /> #3lue,or Black Ink my Plea* .. ., ,. .PROJECT SIT NFORMAAT N <br /> PROJECT SITE ADDRESS: 3 0 I W i4t(K I.L'Teo BLV>fl PROPERTY TAX#: 00 60 6 2 0000 410 I <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> NTAt% <br /> OWNER NAME: H104) YO(,/ANE/ LG L." TENANT NAME(If Commercial): 51t7T 7L. <br /> OWNER MAILING ADDRESS: STREET 3 D l 14) /(/l G)I ! (3L U D y"�v/"r/► <br /> CITY avERSTyT STATE ZIP qg 02 3 <br /> OWNER PHONE: C 3/ "" °Iz9 OWNER EMAIL: Inheek / hots-na"I. <br /> CONTRACTOR NAME: 7, B, D. C t RCbY`s Vc�love �L\L C <br /> CONTRACTOR ADDRESS: STREET �-�6 I 1-1-1.1-t" S�. SW /► <br /> crY L-I nv- o d STATE �A ZIP 9`ip <br /> CONTRACTOR PHONE:2-06—S tk3 - 4{0S 2 CONTRACTOR EMAIL:Sm 5cinev6rna;t ,fav" <br /> CONTRACTOR LICENSE#(REQUIRED) LC Ct CQC S440O3 CITY OF EVERETT BUSINESS LICENSE#(REQUI D)� 1 fS <br /> � .» <br /> PRIMARY CONTACT: 1:3 OWNER 0 CONTRACTOR OTHER(Please Specify) CH <br /> CONTACT NAME: ti/L. ARC//?et—M, LLL CONTACT PHONE: 42.s _6 3r <br /> km4v4rAyui I & CONTACT EMAIL: d kbae k @ u1/arc / lacus,GOm <br /> B IIID cPE 'IT.APP `iATIO ! <br /> Existing Use of Building: M -- ieeia.;I Contract Price of Work:$ �L 3)000 ,°i <br /> Proposed Use of Building: /4/1- Retdta I CN0 d rns8.-t) Heat Source: IJGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial Olndustrial <br /> Type of Project: ❑New ❑Addition eRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> `av` efe/o 1 TE24-rto,V To Errs7//✓G RE-p/_ S ro Q v /ova 191-44. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PEI MIIIT APPliCATI©I�.< P1,tlMBING PER MIT APPLICI TIO N <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-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 /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and coned.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 /> City of Everett Official Use Only <br /> ��� 4/441 f7 PERMIT roq-d09 <br /> Owner/Authorized Agent Signature Date (Revised 9/2 16) ` <br />