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PERMIT APPLICATION <br /> 100,/1170,/,:.7.4` BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everettepstxverettwa.gov I www.everettwa.gov/permits <br /> (Blue,or mack Ink Only Plensoe) P,EE4EVTSITE4M:EE.Ite14TkkIq <br /> PROJECT SITE ADDRESS: .. 4 I-210arid tie_ PROPERTY TAX#: <br /> -LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY -e.re STATE 1.444., ZIP qgc72011 <br /> OWNER PHONE: - » 1 OWNER EMAIL: d! "kiet Io <br /> CONTRACTORNAME: CrYt ti n <br /> CONTRACTOR ADDRESS: STREET 1 t416 Tc5f <br /> CnYedoegely: STATEZIP ' t i <br /> CONTRACTOR PHONE:Lt" 5 a5-/ 05-50 CONTRACTOR EMAIL: d ie i1Dr l'1^L ✓tCetyvel <br /> CONTRACTOR LICENSE#(REQUIRED): rr1Ylt l rte, ea11d YI fcrry OF EVERETT BUSINESS LICENSE (REQUIRED): Ite <br /> PRIMARY CONTACT: 0 OWNERctf <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE. (,,, a5 tpe� i <br /> CONTACT EMAIL; ` . M <br /> BUILDING poittAtt:op 4CA (I t <br /> existing Use of EWIng;,,, Contract Price of Work:$ -- <br /> Proposed Use of Building: Heat Source: KiGaS ❑Electric DOther <br /> 'Building Typt:. ZSFR-Detached ❑SFR-Attached .)Dttex OMuitl-Family of Units: ❑Commercial ❑Industrial <br /> Type FlOject: ❑New ❑Addition ❑Remodel i❑ apair ❑T.I, °Sign °Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 2f 4 Ar I/4 /se/04fal./Pe/Zit" `r . <br /> ASSOCIATED BUILDING PERMIT#(if'appilcabiel; <br /> MECHANICAL I ER Irr APPLICATION PluMM B.Na PERN(I°("AppuctaioN <br /> Type of Project: New Addn _Alteration Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of <br /> Fixtures List of Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures 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 Boiler Lavatory,Wash Basin) Drinking Fountain <br /> J Water Heater Refrigeration `Shower Floor Drain <br /> Gas Fireplace Wood Stove. ,Kitchen Situ .DISftasal Grease Trak <br /> Gas Range v Ducting 'Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other Clothes Washer <br /> Medical Gas... <br /> "Range Hood <br /> g Water Heater Other: <br /> Exhaust Fan Sink(Service/BarFMopf to=. ............. Other: <br /> 1 <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.Vitali 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> orrect4. <br /> � 17 <br /> ` ' <br /> ,Owne Authorized <br /> Agan ignature Date (Reviser/0/23/2016) <br />