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I II PERMIT APPLICATIO� 7u■ � <br /> BUILDING] INECHANICAL / PLUMBING /SIGNTSPRINKLER/ DEMOLITION <br /> ,/ �� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or,Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 52.S) CO LBY AVE, PROPERTY TAX#: 00 43' ) 76 MVO <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ��.•.ff CONTACT INFORMATION <br /> OWNER NAME: UNITY CE/f j or fixtri VE LI V)S ?6TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3231 Cl3LBY AVE(V Va <br /> CITY ^V`F V^1 l STATE fWA- ZIP 1 SZO' <br /> OWNER PHONE: 42,.S"^2613-22 44 OWNER EMAIL: GVt t UNI f T/e'c1„Vl",C(. GOW1 <br /> CONTRACTOR NAME: Al( Cdoeirj COvictrao4 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP (� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: /�,) <br /> CONTRACTOR LICENSE#(REQUIRED): /311 e,'391 Ka CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):` <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR [it/OTHER(Please Specify) Ar0y4GGr <br /> CONTACT NAME: M % )^JACK� CONTACT PHONE: )2.S'-2 S'1- 0 S�& <br /> $OTSStN A4* 4- MLI. A r ECtS jj_� t <br /> 2 OAKES tvE../4 IOO/EVW-errWA (7/124/ CONTACT EMAIL: ��'� bhvlQYC14 • G�1w� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: C(.w p.c n Contract Price of Work: $ ros,o' <br /> Proposed Use of Building: CAveci.. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: LiCommercial ❑Industrial <br /> Type of Project: ❑New LlfAddition ❑Remodel ❑Repair I131.1. ❑Sign ❑Sprinkler ill Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: T Ik - AmIT 10t4 of A- hivyxI ..Lev^-'og.. At p AO A'Dh <br /> COMPLIANT gelrgOOM Atop ReMoDEL. OF AAAI F-xIStI n!& 1ZOSTRoofrt . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration Repair Type of Project: New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump _ Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater BathtubUrinal <br /> _ <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 /> 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> - ' <br /> Number of Heads <br /> ACKNOWLEDGEMENT: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 /> 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.I am the owner,or I 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> /,/ c /6 PERMIT# Bi (erf6,_ L /�/ <br /> O erlAuthorized Agent Signature Date (Revised erl.A0' <br />