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<br /> A#111°' PERMIT APPLICATION
<br /> BUILDING 1 MECHANICAL/PLUMBING/SIGN I SPRINKLER 1 DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERL i,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepsaeveretNia.gov1 www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: 430 ID'.Liotsi-n,c) iv....._,.. , ,,.-11 PERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach Copy of long legal description)
<br /> S.:2 ':j: ' :::''':„...1‘: V.:S .:. , . ..-'''-''' .40..t#7.441,1117.0!0*-0.4**01437. :7•.:!'"''''': 1:''.'.'-1.';..11i''NiC.Aq'- :':'"''.''1'''''':...:-•'':F.i'V'.;::.:.Z'':'!
<br /> OWNER NAME:t10...,rv(. ti TENANT NAME(if Commercial): ; 1 WA c .
<br /> OWNER MAILING ADDRESS: STREET i 3 4-fe).. ---- 4/511.41 C0t44,-1—
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<br /> cnyTh ,fe_.-4 hie-47 STATE 14344....., zip
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<br /> OWNER PHONEel,f51—. 34:44't" OA tido OWNER EMAIL:
<br /> CONTRACTOR NAME:/Iii
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<br /> CONTRACTOR ADDRESS: STREET .41-7 i*) <6-74-k' tet?"-t 0
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<br /> CONTRACTOR PHONE: itio-3sio. .q9/ 7 CONTRACTOR.EMAIL:ntiretStreiTh ,,,`i 0,
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<br /> CONTRACTOR LICENSE If(REQUIRED):()VT CA,. .-1-tfrA. frt k.,,11,401 JCITY OF EVERETT BUSINESS LICENSE#fRECtUIRE0):
<br /> PRIMARY'CONTACT: El OWNER pONTRACTOR 0 OTHER(Please Specify)
<br /> CONT CT N- E: e" CONTACT PHONE: 00 —3V., _
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<br /> CONTACT EMAIL: iii oral 6 Y CO ityle,asi-, -
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<br /> Existing Use of Building: Contract Price of Work:$ 94I
<br /> Proposed Use of Building: 00 Heat Source: OGas 0 lectric Clothe
<br /> Building Type: OSFR-Detached OSTR-Attached uplex 0Multi-Family-#of Units: Eloomrn, cial Olndustnal
<br /> Type of Project: ONew DAddition ORemodel ORepair Ott. 1:3Sigrs 1:1Sprinkler 0Dem•-",.- 'change of Use
<br /> DESCRIPTION OF WORK: , )
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ',-**OHARtiti*,,,priout oit4046-fr-iFyi:n ,,„-,‘,, , '-:::-:-41'; ';',''S:00001$4510-010:tfr#1. 2414**,;;:c.5`; ',,,',,*,,,--i,'„-,?;:::-'
<br /> Type of Project: New Addn _Alteration Repair Type of Project: _New Addit _Alteration _Repair
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<br /> Fixtures List of Fixtures *°r List of Fixtures Fbd*°f List of Fixtures Fixtures*°f List of Fixtures
<br /> . Fixtures ures
<br /> NC—Air Handling Units Heat Pump Toilet 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 11Vpod Stove ' Kitchen Sink&Disposal Grease 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/Ear/M0p/Otc,1 Other:
<br /> 00$4:014:0401/******1**.f00*
<br /> !Chemical or Water I No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and coned 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.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Contractors Law 18.27 RCW and 298.200A WAG'.
<br /> City of Everett Official Use Only
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<br /> it) 25)17 PERNIIT
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<br /> Owner/Authorized Ant Signature ate (Revised 9/23/2016).
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