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I
<br /> PERMIT APPLICATION
<br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRII�IKLER/DEMOLITION
<br /> a= CITY OF EVERETT PERMIT SERVICES
<br /> c. - ! 3200 CEDAR STREET,EVERETT,WA 98201
<br /> ��_� (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everefiwa.gov i www.everettwa.gov/permits
<br /> Cali):®u i it ')AM!0.1[4. .6) ' :I. )P G, , 030.0' 4ir1 i I ctio A1711QI . . ,
<br /> 14 C.b . •
<br /> PROJECT SITE ADDRESS: 77on/ie. /1-W-- ,PROPERTY TAX :
<br /> LEGAL for new construction: Short Plat/subdfvfsion
<br /> Lot No. (attach copy of tong legal description) 4
<br /> 1.:::::.. •(... . '!- .-Is:: e. .. 0.451 }1 s/..+01`nFi1„7)�c.,®0*, 'tT1.1®k�1 : .. .. • .. . • `. .t ...i
<br /> OWNER NAME: "{A VIAL(, —T4(0`(0 � TENANT NAME(If tCoJm'mercial):
<br /> OWNER MAILING ADDRESS: STREET V-F dem' iZc 4 L X(. I . ' ,�
<br /> alit' `l�ii(-,d 2.e/c't STATE W1/'1 . ZIP ���
<br /> OWNER PHONE:
<br /> C24?) .q,IC....,...! 1 ..,,..... .,, !OWNER RIMA .. . .... ,.y, b....,... . ..�,<,,. . ...,
<br /> CONTRACTOR NAME: (a C7( 5 - c'`'Ad-
<br /> CONTRACTOR ADDRESS: :., , 7)
<br /> STREEr 2 E ZC �
<br /> I • CITY M f-.' - STATE (.1-94N ZIP li V2-0 k
<br /> CONTRACTOR PHONE: c4-z.-5") °W2--- �
<br /> ,g(( " !CONTRACTOR EMAIL: f -cI& 671 f.uGf:.r�ii
<br /> CONTRACTOR LICENSE#(REQUIRED}: 2 35Gs ' n� CITY OP EVERETT BUSINESS LICENSE#(RE4UIRE0): 17f,�
<br /> 'PRIMARY CONTACT: El OWNER 1(CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:(its—) 2 ,—072;7
<br /> 1,24-:`--:--1,-) t cON TACT EMAIL: (A-d 0 v�..51.4Gf.a...Ze
<br /> ,,; ..,. BL11tI N@•.PEFRMIT:APP :IcATZON • ;. •. _ • ..
<br /> Existing Use of Building: Contract Price of Work:
<br /> Proposed Use of Building;
<br /> Heat Source: *as EiElectric Et other
<br /> Building Type: USER-Detached USER-Attached ElDuplex OMultl-Family-#of Units: QCommerolal ❑Industrial.
<br /> Type of Project El New EiAddiflon ORemodel ElRepalr CIT.[. �igA t t�Sprinkl' er �D�of 1�Change of Use
<br /> •
<br /> DESCRIPTION OF WORK:13, C 0/13. ,, EZU c Tu' "
<br /> ASSOCIATED
<br /> D(BUILDING PERMIT
<br /> #(i�ff{a�•pplic�/apb�le): yip@ j{�ryp� {� y�$qy---{p---6��T�prys �n p�_
<br /> .;•'''..:.i5:. CIWORPAIP/iAL+: rQrll;�ssC 1 •f�-A•Yb �A'c)1. • I I • '•• : IPIA 011t e'PIE M,�111 t:/..+P L4110 4,,18Ci ,' ,
<br /> Type of Project:Forced Air Systems
<br /> Gas Piping
<br /> New Addn Alteration _Repair Type of Project:•_,New Addn Alteration Repair
<br /> of
<br /> 0 of List of.Fixtures Fix res List ofFiYtrires of fist of Fixtures Fixtures List of Fixtures
<br /> Fixtures Fixiures
<br /> A/C—Air Handling Units \ Heat Pump Toilet BackflowPreventer(Inside Bldg)
<br /> (, 1 Unit Heater Bathtub Urinal
<br /> Boiler Lavatory(Wash Basin)
<br /> , Drinking Fountain
<br /> Refrigeration Shower Floor Drain
<br /> Water Heater I Grease Trap
<br /> Gas Fireplace Wood Stove i Kitchen Sink&Disposal
<br /> Gas Range 1 Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: • Clothes Washer ! Medical Gas
<br /> Water Heater Other: •
<br /> ExRahaugest
<br /> t Fanood Sink(Service/Bar/Moplefa)I Other:
<br /> Exhaust Fan • .
<br /> ::::9.;.::.TOIMIJOIL10./• 1PI .11 4.1. 1t0At.'1;,M1,. . ,. I ; I I
<br /> Number of Heads
<br /> tCKVOWLEDGEMENT:/have reviewed this application end confirm the Information contained herein Is true and correct.Work done pursuant to this permit must comply with
<br /> :Intent federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom,p�ia�nsmustfirstbe authorized In writing from the
<br /> 3ullding Official before being authorized under any circumstance,i em the'owner,or i am authorized by the owner of this properly to perform the work for which application is made,
<br /> !ad/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of6Vereff Official Use Onlyf ( PERMIT O ./�Db'
<br /> leA g .4. m
<br /> ff ‘ f II
<br /> •
<br /> i ,
<br /> Date (Revised 5/20/2016)
<br /> I
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