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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps@everettwa.gov j www,everettwa.gov/permits <br /> `13140,,Pr Slat .Ink PAIsf,tI ) P OttliiITO.,( ,� „',71)10N <br /> PROJECT SITE ADDRESS, 41, 248 kr 0 eertojtil- r' PROPERTY TAX#; <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> 'CONTACT INFORMATION <br /> OWNER NAME: KIM I verseei TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE W 1/, Z11_+ 3 <br /> OWNER PHONE: . 2 ': s OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> LT 1 n& <br /> CONTRACTOR ADDRESS: STREET 18115 y'btJ.d <br /> CONTRACTOR PHONE. t [CONTRACTOR EMAIL: ebbe P � 1e 10 4, <br /> CONTRACTOR LICENSE (R'EQUiftecr C�,�f r yl * <br /> � '(;#r ti ��Z.LI 11 CITY OF EVERETT BUSINESS LICENSE REf� fFtEil) <br /> PRIMARY CONTACT: D OWNER lid CONTRACTOR D OTHER(Please Specify) <br /> e. <br /> CONTACT NAME CONTACT PHONE: Lias <br /> +r * CONTACT EMAIL: I� ;. I e; Cs to <br /> Existing Use of BUiidl ::_ Contract Price of Work: 2.0 <br /> Proposed Use of Building; Heat Source: Xas ❑Electric DOther.. <br /> Buiidihr s ;re. _ FR-Detached ❑SFR-Attached ❑tiu¢iotlC Units.'❑Multi-Famil i::of O� <br /> '” j�T ElIndustrlal <br /> Type of Project: ONew DAddition ❑Remodel ❑i epair OT.I. ❑SighDSprtnisier DDemolitIon D+ jtange:of Use <br /> DESCRIPTION OF WORK: • <br /> 1 n*{ztt, t4 a5unsex-TS <br /> ASSOCIATED BUILDING PERMIT# if ao'p iloablg <br /> MEOHANICAL P IT A i II AVIO„i� L UMBINr..P tMIT 110, ATI <br /> Type of Project: _New _ Addn Alteration Repair Type of Project New -_Addn _AlterationRepair <br /> List of Fixtures <br /> Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> A/C Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced:;Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping y Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration: Shower Floor Drain <br /> I Gas Fireplace Wood Stove . Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher <br /> Roof Drains <br /> Clothes Dryer Hookups Other: - Clothes Washer ': Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan, �e z <br /> - Sink(Servlce16ar1MtoP/etg. _ ' Othet':; <br /> SPRINKLER/SUPPRESSION SI S t"S;`l'EIVI <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.ti4*:done pursuant to this permit must comply with <br /> current federal,stale,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./am the owner,ort 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 /> CO of Everett Official Use Only:. <br /> � •j, PERMIT# �Ul_ (� <br /> 'Owns/Authorized Aden;, Ignature Date {liel+jsaa s ,,2P1 ; <br />