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• <br /> of,LT PERMIT APPLICATION <br /> BUILDING i MECHANICAL J PLUMBING/SIGN/SPRINKLER/DEIIJIOLITION • <br /> cifY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov(wwevttwa.gov/permits • <br /> (6W6'cii 131€ k int knr3t.> ie gje) ' : PROJECT SATE <br /> ,IINF® [RtvlAAKO .. w. ere • <br /> PROJECT SITE ADDRESS: (1 12.* V -�pA t5 71 Y(k . ,PROPERTY TAX#: ' <br /> LEGAL for new construction: Short Plat/subdivlslon Lot No, (attach copy of long legal description) <br /> . • ,CORtAit l iktVORMAT('i®N9 • • • . . . <br /> OWNER NAME: Vt k TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STRET( (4 I L 3) (y • <br /> CITY STATE � . MP `1/�8�3 <br /> 1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: E Vb.1,R.C2 \.J 6 B`l -rL �?ff cc-7-WL C. <br /> CONTRACTOR ADDRESS: STREET 2-(20 (14C.4 Fit. Aug . <br /> CITY vutly STATE (At' — zia /S'e/ <br /> CONTRACTOR PHONE: 4S.5.•2.5'2.-3i ttp • 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CQ •5S gy2.2_p T' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 b r 5". <br /> PRIMARY CONTACT: fD OWNER I29,CONTR4CTOR 0 OTHER(Please Specify) w., ., ....."' <br /> CONTACT NAME: CONTACT PHONE: 475--2-5-2-,//9 <br /> / ' CONTACT EMAIL: <br /> .. . . . • .•• .• '• SCJII<<.t1 gNG Pt NiJT Af PLidA`P)(®N , _— - <br /> Existing Use of Building: i Contract Price of Work:$ j6 «/ <br /> Proposed Use of Building: Heat Source: DGas DElectrlc DOther <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CIindustrlal <br /> Type of Project: ONew DAddition DRemodef ❑Repair DT,I. @Sign @Sprinkler @Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> V`/f IC.U, g AS &rate• i4) l <br /> I <br /> ASSOCIATED BUILDING PERMIT#(if a.pllcable: <br /> ; •IiV/ECH.I NXCAL,P> Rli/IiTAPPLKCA•TiOkkI I . • • , PLUMoft(G Platy[ TAPPLVCATI®•F4! <br /> Type of Project: ^New Addn Alteration_Repair 1 j Type of Project:_•New Addn Alteration Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet r Backflow Preventer(inside Bldg) <br /> I 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 11111 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 /> '.. .•s k'LN{LER/.1.PPtRESSiOg SYYTEM ' ' <br /> L '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 properly to perform the work for which application/s made, <br /> and l comply with the State Contractors Law 18.27RCWand 296.200A WAC. <br /> City of Everett Official Use Only <br /> Ke/y1 Gato 0 t1-0P1-21A PERM T t , ‘,..... Oryl . <br /> )wneriAuthorized Agent Signature Date (Revised 5/20/2018) f <br /> 1 <br />