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PERMIT APPLICATIOr l", <br /> /:11111/%'/V--A!'.77 <br /> BUILD I MECHANICAL/PLUMBING/SIG11I"J RiNKLER 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 I(E)everettepsieverettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: raj 1(' I Lor—t6/00AV t$ 'PROPERTY TAX#: 0:74.4i5 809130 0 boo <br /> o <br /> LEGAL for new construction: Short Plat/subdiivision(.A!i/1�GZ f �j T1�8�No. (attach copy of long legal description) <br /> OWNER NAME: L0V-12. '4-&I(c C-e f L v fejt TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 151 b.. ., ),(ck lItlit, <br /> Cnv >✓\Lu( . STATE W A zIP CN/LOS <br /> OWNER PHONE: al; OWNER EMAIL: R.�I\ tb� \`.C.CIAA <br /> CONTRACTOR NAME: lid c5YrL5„,0(\ 4 �..w., . <br /> CONTRACTOR ADDRESS: STREET ' clOA 3Q..9c ¶\b u1/4.99--po.pk <br /> CITY f\OV\CYPA,15\f‘ STATE W ZIP Ck%/2:1.\ ` <br /> CONTRACTOR PHONE:I-6(0D se6 141 j 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): TES Mme`()Vije,4 CITY OF EVERETT BUSINESS UCENSE#(RE• - D):I / ## <br /> PRIMARY CONTACT: 14 OWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (. ,3 <br /> j � - ,o <br /> kjiva 1_ `'^ `` CONTACT EMAiL: v.. tx, fo1icfl.e r0g►na:A_A.,rx„n <br /> : >: >::<:;>:;:;.!>:-><>::;.;:.;:;.:.;;;;;;:.;:.;;::.;;:.,;>:;::<:>;:;:<.;>:.;::.:O::;:>:.;::.;:.;;:.;:.;:.;.-IIS.. I►C............................................................. <br /> Existing Use of Building: ,S P. .' Contract Price of Work:$ __ <br /> Proposed Use of Building: j� Feat Source: OGas Electric ❑Other <br /> Building Type:13SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ,, DCommerciai Dindustrial <br /> Type of Project INew "DAddition ❑Remodel °Repairr(��❑T�.I. ❑Sign ❑Sprinkler_\WlDemolition DChange ofUse <br /> DESCRIPTION OF WORK: pier G.YId- 11 ckc,x•-�•lc ol.. ADQ.\\"„64r_c , 4.231 ‘.e.� ('tER-(�-+-\ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IxAR.14`ik'I::'II#3N:.;:.;>::::;::.,:. :::; I y tro <br /> Type of Project New_ Addn Alteration Repair Type of Project:LNew Addn Alteration _,-_Repair <br /> #ofList of Fixtures #of list of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> 1 Forced Air Systems Unit Heater 2 Bathtub Urinal <br /> Gas Piping Boiler 5 Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration i Shower Floor Drain <br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap i <br /> g <br /> Gas Range Ducting ) Dishwasher Roof Drains g D .iS 0 i <br /> Clothes Dryer Hookups Other: d I Clothes Washer Medical Gas <br /> 1 Range Hood Other. <br /> ' '2j Exhaust Fan ,t{-S . i Sink(Service/Bar/Mop/etc.) Other. t <br /> (L a, teltit._• ?:) .. :.:. 4- i-bce iI <br /> SF..::RINKLIWI:/SUPPRESSIEO f SYSTEIAi1s»'g::::' : <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.tam 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 /> PERMIT#/ • <br /> Lel DiD ?—o, i .,�► ..i ?-.4- ((^� <br /> • t —,'r T iz-•_•�� -ignatu e 1!-- Date (Revised 5/20/2016) <br /> i/ } <br /> l/ ` Z--- <br />