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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING /SIGN/; �INKLER I DEMOLITION <br /> e,"111" CITY OF EVERETT PERMIT SERVICES <br /> !++Nlial 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 /> _. .. ...... . . _ ._ .. ..__.. ..: ,,., ....h`ROJ#GT$ITE4:NIk.t31Rfi11AT10N. <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> ,DO 11,4,` (G AVE. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . . . . ...: .. . . :. . i .:.:....'. :..:....: ... • ONTA4?T:�WFORMATI'ON';` 7 ° ;. . <br /> OWNER NAME: 1er1 o"(tVNGE B 4TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET th'1 Z(( &swe' " Ail' • /� <br /> CITY M -e 1 STATE WA ZIP cb( 40 t <br /> OWNER PHONE: OWNER EMAiL: <br /> CONTRACTOR NAME: /A.A. MO I ' -W - 1 f4 <br /> CONTRACTOR ADDRESS: STREET 102.(A`i4 l'a , (V. 4 <br /> ' <br /> CITY K41I LA t tt7 STATE WA ZIP 4)1;4 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: . <br /> LICENSE#(REQUIR DO2s1 CITY OF EVERETT BUSINESS I'� <br /> CONTRACTOR LICENSE#(REQUIRED): ... .... . ..... .... r.. ... . -. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR lig OTHER(Please Specify) ASK tro <br /> CONTACT NAME: vti1/4.4 d&ifty(„414. CONTACT PHONE: (4250 y q.g8t'of'S <br /> CONTACT EMAIL: de,viria beihar .h.ccscn <br /> _:__:.. MitI__::,,._.._•.:.__:::_:.::___v:-... a!A:::.<,.,ABUaLD N0PE.Rl1t11__CAPPLI0.71I0N=15R-5:1=: .: .... <br /> Existing Use of Building: A/i .'1'(a.(.. to /f/L(Srt 'e Contract Price of Work:$ ZOO,OGD, 00 <br /> Proposed Use of Building: it ( (, 14 zy isrJ(gC'4' Heat Source: ❑Gas DElectric @Other <br /> Building Type: @SFR-Detached @SFR-Attached ❑Duplex ClMulti-Family#of Units: IgrCommercial @industrial <br /> Type of Project: @New liZrAddition @Remodel @Repair 07.1. ©Sign @Sprinkler CiDemolition OChange of Use <br /> DESCRIPTION OF WORK: �t ('{LLilir>lV 45t= 2i49°a f'4.1-3 "A.-te#4z A f"okF" ( <br /> ,V) A14 Itee-f •74=5 ' LYS -la -1146 lax v't t4 * W cc.c,u' Y 4I-4(G.t7 - iS <br /> Ge; tz . ----- - ______ - --- - -- ---- -- -- - <br /> ASSOCiATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL it#M1T APPI IQ411:ON; • , :.- P.140.B1Nt .PERMIT tm:N <br /> Type of Project: New Addn Alteration Repair Type of Project: ^New _Addn Alteration _Repair <br /> #of #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures #of List of Fixtures Fixtures <br /> Fixtures Fixtures <br /> AIC-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 /> Water Heater Refrigeration Shower Floor Drain. <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range <br /> 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 /> :: :';:: :"::;SP:RiNKLER-/SUPP110$IONSS 0TEM=::.,�:::::.: <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!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. City of Everett Official Use Only <br /> PERMIT 1 1,0-6017) <br /> lb• it• tCPr <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) ..w <br />