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PERMIT APPLICATIml <br /> �,./— BUILD1410 MECHANICAL/PLUMBING/SIC SPRINKLER/DEMOLITION <br /> ! > ..7d-, <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 /> -Pi;: ® ip�` t '1 x h'v� uVt qv'=0.L 3w <br /> FR�OJECT SITE ADDRESS: � C '9\ 'PROPERTY TAX#: <br /> t _ �� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. 1: attach copy py of long legal description) <br /> •___.., ,. I, t . w. _..sfn. ...,. . ..r,.. _. z ....,.AI,n W _©, ..� L>., :;,,ti i?` �...>,. ...,.. . .. + .. 1 i s ,=gas <br /> OWNER NAME: �t�<i(, v � .. .� <br /> -f G ��C o -�l(1�1�S TENANT NAME(If Commercial): <br /> QWNER MAILING ADDRESS: STREET t-LCj' k. szz ‘\ %,e( . <br /> I7� <br /> I CITY \ l` STATE Vv ZIP G t4 Z <br /> i <br /> WNER PHONE: J- 'OWNER EMAIL: <br /> JONTRACTOR NAME: \(\k:11- C O Orcc c- cl UV\\O;n <br /> CONTRACTOR ADDRESS: STREET 14k 0\ 6014.`( \ S'N. ((_ <br /> 1 Crvv Y l ' \\ t. STATECOA ZIP \C D j <br /> C , <br /> GO TRACTOR PHONE: -km- H-0 - CONTRACTOR EMAIL: 4�'- WEc;\-CeCk \Uitt'e1�1 1\C 1 �I <br /> CO TRACTOR LICENSE#(REQUIRED):\ %A—CG i <br /> -�` �U (CITY OF EVERETT BUSINESS LICENSE REQUIRED 3 ' V <br /> FRI'VIARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> GONTACT NAME: .,� y O� ' O 0 l t1l <br /> CONTACT PHONE: <br /> c‘RSSC . % C " CONTACT EMAIL: <br /> II <br /> Existing Use of Building: Contract Price of Work:$ S5Mr). <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Typo of Project: New ❑Addition ❑Remodel ❑Repair CIT.'. ❑Sign Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OFINORK: <br /> ik\ <br /> ASS \(,€ W 8(kAVa{ \\ s -rA\\ck .N)'" COSI © — OZ <br /> OCIATED BUILDING PERMIT#(if applicable): <br /> ,,a. Y g <br /> 'TOe of Project: New Addn _Alteration Repair Type of Project: New Addn _Alteration _Repair <br /> #of #of #of f <br /> #o <br /> Fixtures List of Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bid <br /> I Forced Air Systems Unit Heater Bathtub Urinal <br /> 1 I Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower <br /> ! Gas Fireplace Floor Drain , <br /> Wood Stove Kitchen Sink&Disposal Grease Trap I I <br /> 1Ducting Dishwasher <br /> Gas Range Roof Drains I <br /> ! g <br /> I Clothes Dryer Hookups Other: Clothes Washer Medical Gas I <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 1 <br /> 1 Chemical or Water 1 its INo.of Heads <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 <br /> cu nt 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 /> Bu i Official beforebeing authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is ma e, <br /> and! mply with the State Contractors Law 18.27 RCW and 296.200.4 WAC <br /> i <br /> City of Everett Official Use Only <br /> 1 PERMIT <br /> - t -7 I 34_, IDS i <br /> Ovine I/Authoriz d •‘,:nt Signa i Date (Revised 9/23/2016) 1 <br />