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PERMIT APPLICATI <br /> BUILDIMJ MECHANICAL/PLUMBING/sicip SPRINKLER/DEMOLITION <br /> I 0.47 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> `PROJECT SITE ADDRESS: � � ki v\- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: ?AGA-h C, g-tdole ry nS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t-k�a.` to"r( `\ %_'(� f Vi <br /> { CITY lk V...441 <br /> I STATE ZIP�f l Cul <br /> QINNER PHONE: to -S,-- LA S —t OWNER EMAIL: <br /> CONTRACTOR NAME: W(-'Nj"t" C 0 Q ct tArn\O\n <br /> 1 <br /> CONTRACTOR ADDRESS: STREET 14t I?\ a DLi`(Y\ S.v ((I <br /> I cry r 1 ail 'vl4 STATE LOA ZIP Cn'r t1, <br /> tf0 TRACTOR PHONE: 6(ED- ip ' CONTRACTOR EMAIL: l\\ lPkYlyI ■ <br /> CONTRACTOR LICENSE#(REQUIRED):\N `\Cc. <br /> -p ,1 , kCi CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 3. n <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> ONTACT NAME:\,��t � CONTACT PHONE: • ' Q . L4�' y ,O C)v 1 <br /> "\-kr` l t�'`` ‘n" CONTACT EMAIL: <br /> xis ing Use of Building: Contract Price of Work:$ -g( t) <br /> Proposed Use of Building: Heat Source: ❑Gas CI Electric ❑Other <br /> l uikiing Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: CI Commercial ❑Industrial <br /> ijipe of Project: N.ew ❑Addition ❑Remodel ❑Repair 01-.1. ❑Sign 1Sprinkler ❑Demolition ❑Change of Use <br /> I)ES�,CRIPTION OF ORK: <br /> ' \\ W\(\vou.,{ \`(1)`\Gai o 103I <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 7 v.� :.. - -. ,� 'SAP F :4 . ,w„G*` . � TI� <br /> T ipe of Project: New _ Add;Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> i # f List of Fixtures #of #of #of <br /> lint res List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> 1 NC—Air Handling Units Heat Pump Toilet <br /> Backflow Preventer(Inside BliV <br /> I I Forced Air Systems Unit Heater Bathtub Urinal f <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 /> I Gas Range Ducting Dishwasher Roof Drains j I <br /> 1 Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> I Range Hood Water Heater Other: <br /> I Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> I <br /> Chemical or Water q JNo.of Heads <br /> � <br /> ACKN WLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with i <br /> curfrentfederal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writingfrom the <br /> Budding Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which app Ica tion is ma e, <br /> and I comply with the State Con r ctors Law 18.27 RCW and 296.200,4 WAC. <br /> i <br /> i City of Everett Official Use Only <br /> 1 <br /> 4r <br /> 11111"..._ S'- -2,- - ` (q-ocA --O2_3,,_, <br /> Ovine'/Authbten Sign <br /> rIzed s - I . , <br /> t — Date (Revised 9/23/2016) Cs:11 „ <br />