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PERMIT APPLICATIO I, <br /> 11 <br /> - BUILDIN �IIECHANICAL/PLUMBING/SIG <1-J—RINKLER/DEMOLITION <br /> • CITY OF EVERETT PERMIT SERVI <br /> `_,. 3200 CEDAR STREET,EVERETT,WA 98201 <br /> � (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@evereftwa.gov I www.everettwa.gov/permits <br /> 139eu,a.;®p.r:iiic> •lluvls._oaihiPQ0 sem) • . I .G 00.0 9TE•➢(iall cG MATON: ..• • •• <br /> PROJECT SiTE ADDRESS: 2...(257 4) 1044 lit-6lit-6 BI vdPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: a,„:1 -CT5p,, TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 2._t 21 - Lutz-sr- &k{tI(_C- _:3 (3 �J <br /> _ CITY t:-.71/111---t:-.71/111--- STATE LOA• ZIP 49[.1o 3 <br /> OWNER PHONE: ��ZO 3561- 333.... . .Y OWNER EMAiL:.,, <br /> CONTRACTOR NAME: LV'T1d2 o , ,,t-1--, - H04/7' 4, AL <br /> CONTRACTOR ADDRESS: STREET 21 .O 'Oa i-AL, <br /> cm( EVVr — STATE �,e/ ZIP 1 C j f <br /> CONTRACTOR PHONE: (4 2.-51 Is Z- .S((L( CONTRACTOR EMAIL: (L49/A-(5_,.f) J/4 r ie s el,OK <br /> CONTRACTOR LICENSE#(REQUIRED):L-(JC•/26,SSDz2�"(- 5 <br /> • CiTY OF EVERETT BUSINESS L[CENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ((.4.z_ -' 60 e_ 077_Z <br /> l4 liQ T.4-(,b CONTACT EMAIL: geLLQ Q SSJyi Gum cC9ot <br /> :.BUILDING.PERMiT;APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 4 47b0r <br /> Proposed Use of Building: Heat Source: ❑Gas ,Flectric Cl Other <br /> Building Type: FR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> I <br /> Type of Project: ONew DAddition ❑Remodel El RepairX.T.J. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use • <br /> DESCRIPTION OF WORK: f <br /> ..-E- — •(CQ-SS C1( S`W <br /> • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :;::.•NlOCFIAN_iCAL:PEI EWAPKIOA,TM®N• • •- . PL•O IMOING 0ERNi4T:10PLI0ATION _• . , • . <br /> Type of Project: _New Addn Alteration _Repair Type of Project: •___New Addn Alteration •_Repair <br /> #of List of Fixtures °f List of Fixtures #°f List of Fixtures °f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units s 1 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 /> : •::°:;: $P]ftpNKLER/ l9)P.P.RIESSIG1I....)MTEM..: <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.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> PefA <br /> City of Everett Oficial Use Only <br /> t <br /> 1 1' 23 — th PER IT# <br /> Lac -- ocO CO . <br /> Owner/Authorized Agent Signature Date (Revised 5/2/2016) . <br />