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PERMIT.APPLICATION • <br /> � BUILD= MECHANICAL I PLUMBING I SIGi\.'RINKLER/DEMOLITION <br /> s`' CITY OF EVERETT PERMIT SERV! <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)'everetteps@everettwa.gov I www.everettwa.gov/permits <br /> :t..„r....:n':_ ... •.:.-ice:-..,r:- <br /> PROJECT SITE ADDRESS: /y 3(4. c t( cYC " ` PROPERTY TAX#: U 06 00.1--0 o 7 a r <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> — _ .-,:�:.. .� ':1�1�'�':'11NIF�Ai21U(�iT1'tlSYolz"�'`���•:..: . ': _, . - . .. .. ,.., - <br /> _OWNER NAME: 6iv ,1 L . ('1R 4- �..f5 • / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS; STREET 1 j W . et ((z CT L , <br /> crw 1.57./1,44+ . �STTAATE OA ZIP <br /> OWNER PHONE: (qZi� 1-30.10P0 OWNER EMAiL: dime Tl (4G} �-'O/1 -4 S7( ��i4et _ . <br /> CONTRACTOR NAME: 5aft�,c U Aiau+J 12E---Or‘,Co <br /> CONTRACTOR ADDRESS: smmEET S O S 9 • <br /> CnY c-D ,"4— <br /> ,1,C.-- ` LSS4TD5.04-- zP ` VDA9 <br /> CONTRACTOR PHONE: '-'ZS 1I,(0 — h•.2- CO TRACTOR EMAiL: <br /> '� ( CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): <br /> CONTRACTOR LICENSE,#REQUIRED): I v ° e_41,-,-,f -• , _.• _. . <br /> PRIMARY CONTACT: LYOWNER 0 CONTRACTOR 0 OTHER(Please Specify) . <br /> CONTACT NAM . CONTACT PHONE: fikt <br /> l vii (q4 L..\--.5 CONTACT EMAIL: 64,4 <br /> .m - - _ = ,_-` -; _ ; :. te-.AUIDNCPRgore-grirG'A <br /> N =_ ; ` ;. .:: <br /> Existing Use of Building: <br /> Contract Price of Work:$ t D <br /> Proposed Use of Building: Iv4A c.L .d w- 1rrwicip— Heat Source: CIGas ❑Electric L7Other J��� <br /> Building Type: IrS�F -Detached EJSFR-Attached J IJDuplex ElMulti-Famiiy4 of Units: EICommercial Cllndustrial <br /> Type of Project I I ew ClAddition DRemodel IDRepair DT,I. E Sign ©Sprinkler IjDemolition DCharfge of Use <br /> DESCRIPTION OF WORK: ..i k4 „e_r_4rt <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> `�•'�°r'`�•# �A: A est tl�S IY_`i'RI I .P.t g :;.•', .-.' :• P1!C�l10.i.4G•PERMIT::0.PLICA'TIT)•N• . <br /> • <br /> Type of Project: ew Addn _ Alteration Repair Type of Project: New Addn _Alteration Repair <br /> #of #of #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of f fixtures Fixtures Fixtures • <br /> A/C—Air Handling Units Heat Pump Toilet Backflow w 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 /> - .•>;,' *:Sl I.S.140.10:00. ':R `S 0 07 EN ::'_- <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.I am the owner,or lam 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 290.200A WAG <br /> City of Everett Official Use Only <br /> PERMIT# bittok__ <br /> etAi <br /> re e (Revised 10/12/2015) <br /> Ow uthorized Agen natu / i ,1 12_ / <br />