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-- PERMIT APPLICATION <br /> BUILDING I MECHANICAL./PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> 11/4410 -A CITY OF EVERETT PERMIT SERVICES <br /> a 3200 CEDAR STREET,EVERETT,WA 98201 <br /> - - (P)425-257-8810 1 FAX 425-257-8857 1 jl=)everetteps@eversttwa.gov l www.everettwa.govlpermifs <br /> I( Otue°®r iSfalc.(c IthII®.niy.pfeasc�) , - :PEIOJE T SITk INFORMATION <br /> A _ <br /> j�1 / <br /> t PROJECT SITE ADDRESS: /Cl g t,.-ti c -f 'PROPERTY TAX gr <br /> LEGAL for new construction: Short PlatfsubdM$lorr Lot No. (attach copy of Jong legal description), <br /> Lew _ -- <br /> .CONTAiat.INPORIi�ATIOI�1 : <br /> OWNER NAME: f ? $v C� TENANT NAME(If Commercial): <br /> ,,ry <br /> OWNER MAILING ADDRESS:- STREET '7f% ail)V tee/ <br /> ony ( , L1�77 STATE 1,6., ZIP +' <br /> OWNER PHON Ie,/7 GINNER EMAIL _, <br /> ., ,...,. .....�,,. ..... ,.rte „ ' ... <br /> CONTRACTOR NAME E!/�C? fi '5`-6e�( •eJ Ct Z l 'Z ' <br /> CONTRACTOR ADDRESS:. smear '24 2 O e l l A`) <br /> gay SUMiTSTATE Wim , ZIP 61 f;g0t <br /> CONTRACTOR PHONE: 4`25-°2- -2,-311 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED} go P Sqiva,z.0 i* CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) e..36-7G 's • <br /> PRIMARY CONTACT: D OWNER 1 .CONTRACTOR Ei OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L('Ii ,.2.5"2>' IIV <br /> ea 1 S4(a) CONTACT EMAiL <br /> 11 • , . t3illtriI t?ERIVlIT,APp;LidA`TI+3M: . : - <br /> Existing Use of Building: 1 Contract Price of Work:$ _ <br /> Proposed Use of Building: Heat'Source FTas 12klectric DIOther <br /> Building Type CISFR-Detached DSFR-Attached ©Duplex DMulti-Famity4 of Units: Wornmerdal °industrial <br /> Type of Project: DNew °Addition DRemodel IIRepair DT.i. IJSign DSprinkler ElDemolition DDChange of Use <br /> DESCRIPTION OF WORK: <br /> 'aJ. i .- ..5 opic - 'ySTeli-4- T thl)S Id/1,„)-.%-c4) <br /> CF .�, ut~)T5 lkGr Atka-4-Z - -> <br /> ASSOCIA`C BUILDING PERMIT#(if applica Ie): <br /> � , PLUMBING imilitIT APPLiICATION <br /> .: .IYI��iI�.AC�f►C�11.,�EREffIPi`APPLICATION _ <br /> Type of Project: New_ Addn .__..Alteration.Repair Type of Project: New Addn Alteration Repair <br /> #bf #sf #of #of <br /> List of Fixtures List of Fixtures List of Fixtures Listof Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 3 NC-Air Handling Units 5 Heat Pump Toilet. BaclsflowPreventer(tnsids Bldg)IFonced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor brain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal crease Trap <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 Sink(Service/Bar/Mop/etc.) Other: <br /> skalikuet AIIESSIONSYSTEM ' <br /> ' i R' <br /> [Number of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is trove and correct.Workxionne pursuantfo this permit must comp&with <br /> current federal state and local law.The,granting of a permit only authorizes approved work and no deviations therefrom,Deviations must firstlae authorized In wrrtinp from the <br /> Building Offi,Jaitiefare being authorized underany ofrcumstance.tam the owner,on am authorized by the owner of this property to perform the work for which applicationIs made, <br /> and t comply with the State Contractors Law 1E3.27 ROW and 296..200A WAG. <br /> City of Everett Official Use Only <br /> .2---‘.-......-- 44' PERID ''... t..) -.- . <br /> OwnerlAuthiarizedAgentSlgnature pate (Revised 5 0/2t1 fi) <br />