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PERMIT APPLICAT1O11— <br /> BUILDIN�CHANICAL/ PLUMBING/SIGN II MRINKLER/DEMOLITION <br /> A1r'1"'''"A CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810FAX 425-257-8857 E everette s everettwa. ov www.everettwa. ov/ ermits <br /> I I( > p@ g l s p <br /> (Blue or BlackInk Only Please)' PROJECT,SITE INFORMATION :,_ <br /> PROJECT SITE ADDRESS:—70SO LOVA( (1 4e Rai atir4L (,q IPERTY TAX#: 6013C2.- ap-04 p-63 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> - CONTACT INFORMATION <br /> OWNER NAME: O t SI1J 1-1-1) ,Ln ,{.S y LLC, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET p U, x 71(i <br /> L��- n <br /> CITY <br /> .��� y�(,tar STATE,',,�I,J,IL/ ZIP 61 <br /> 82151,1) <br /> OWNER PHONE: it2S-•'.L DP • I J�('` OWNER EMAIL: ©1AYI PL) ,11.41,t,Y U.L(/L e Kb EmOjAA 'o <br /> CONTRACTOR NAME:1),up`' 1 kstunes 1 in C v <br /> CONTRACTOR ADDRESS J: STREET <br /> CITY Evibu,i2c, STATE 'Au ) ZIP q$z(•p <br /> CONTRACTOR PHONE: S• 2_11 6• 69 CONTRACTOR EMAIL: OGj'pit ,men eL/(,l eLL ,a� <br /> CONTRACTOR LICENSE#(REQUIRED) �, J s- CITY OF EVERETT BUSINESS LICE_N, E#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER GI( NTRACTOR 0 OTHER(Please Specify) <br /> 4 <br /> CONTACT� �NAME: n�,1 CONTACT PHONE: -1)• 11iS, <br /> i o uu I`U .&t ' CONTACT EMAIL: p44 , if(, 4 rii tubwitai. evil, <br /> ~. .... . BUILDDING:°PERMIT APPLICATION,.-` . <br /> Existing Use of Building: Contract Price of/Work:$ ' i;�2B5� <br /> 1 . <br /> Proposed Use of Building:ftI e h 'Viell( /) 1�(i� Heat Source: OiGas ❑Electric ❑Other <br /> Building Type: ❑S R-Detached ❑SFR-Attached I9Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: LY New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> rvew CU n.6oi / D / pinha'u <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> `. MECHA ICAL PERMIT APPLICATIONPLUMBIi G PERMIT.APPLICATIONi <br /> Type of Project: I New _ Addn _Alteration Repair Type of Project: 4 New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump LP Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> 2i) <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> ZGas Fireplace Wood Stove 2 Kitchen Sink&Disposal Grease Trap <br /> 6 Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> pExhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <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.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 296.200A WAC. =° <br /> /�"\ 1/J City of Everett Official Use Only <br /> 14")/L) ` !j PERMIT# <br /> 2'/v QiL 4Ilhi - '` CV-101 ~ oOt <br /> wner/Authorized Agent Signature Date (Revised 9/23/2016) <br />