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PERMIT APPLICATI• ''i <br /> BUILDI —MECHANICAL/PLUMBING/SI e- --PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SER in, <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps ci✓Deverettwa gov I www.everettwa.gov/permits <br /> LEGAL for new construction: Short Plat/subdivision Lot No. 13 (attach copy of long legal description) <br /> OWNER NAME: ?A.ot -(-1 C, ?--k dole. 1_I .,�,n eS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET t-A_t C� . "tb \\ ot,..„..kret-- nAki <br /> i i CITY l STATE C/ �( <br /> � `' 1 ZIP"�D\JI <br /> O NER PHONE `''t S� (.. S cam{14 Li OWNER EMAIL <br /> OriTRACTOR NAME: We `1-- C G Gic',-\-- `fit Ukty'\ its <br /> CONTRACTOR ADDRESS: STREET °\14 k ' 6 a(-._j.m Si- ((� <br /> 1 CITY 1`{ f\ STATE ZIP`\ a O • <br /> O+�OiITRACTOR PHONE: Z(,Q(' o-;- C� CONTRACTOR EMAIL: 1� , <br /> CI l �'l�bl��C.��11�VY1�iY1 IYl C, �-`� <br /> ONTRACTOR LICENSE#(REQUIRED): \Neci�CC lb <br /> .,,,...,�._..,.. _ ��.,�,,,_� „___„�. . _.._w,___ , S ,,D CITY OF EYERETT BUSINESS LICENSE#(RE4UIRED) 3 <br /> PRIY CONTACT: D OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> IfeiAR <br /> CO TACT NAME: CONTACT PHONE: ??DL,t4C) - LA D'�- 1 ©O k---) <br /> \‘‘I\S\0(3 ` ,t CONTACT <br /> Existing Use of Building: Contract Price of Work:$ g(MD. <br /> Proposed Use of Building: Heat Source: DGas ❑Electric ❑Other _ <br /> Buikiling Type: DSFR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial I1 <br /> Type of Project:INew DAddition ORemodel ❑Repair DT.I. ❑Sign kSprinkler ❑Demolition DChange of Use ` <br /> DESCRIPTION OFINORK: <br /> • CSto - ©z9 <br /> ASS CIATED BUILDING PERMIT#(if applicable): <br /> .,,i�' A .�,a' '<' 4 ... �3.^z......�>,`k �.,a., ,._�4�0� R11111�rt.�l�ll3�.._IG �t 'gar,.; _��r <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> # f List of Fixtures #of #of #of <br /> F3xt res List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> I 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 /> • <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> ` Exhaust Fan ' i <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> i <br /> I Chemical or Water ! 1 \ INo.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct.Work donepursuant to this <br /> curpen federal,state,and local law.The grantingof a permit must comply thh <br /> permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from thel <br /> Buiidi Official before.: authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I mply with the - =Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> k� ' <br /> PERMI # <br /> �. z---,Z I -02_ 1 I <br /> Owner,/Authorized Agent S ,nature <br /> Date (Revised 9/23/2016) :, <br />