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• PERMIT APPLICATION <br /> BUILDING(MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION - <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (P)425-257-8890 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.evereftwa.gov/permits <br /> (Blue•®r b falai!(ink Ontj(•ffkeasse) . : . PROJECCT Stitt imckitilitainiON l' • e • <br /> PROJECT SITE ADDRESS: ' '3 'Z ,N 1)2, PROPERTY TAX#: <br /> LEGAL for new construction: Short Hat/subdivision Lot No. (attach copy of long legal description) <br /> I • • • ..CO TAdT liMPOliMiATK®NI . ' • • ' , <br /> OWNER NAME: !/L�9 be4- fiN-wit \TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �(p 33 c.O,..44,...) / ,Z., / / • <br /> L=- <br /> CTIY L/ STATE LSA. ZIP q 2.nl 1 <br /> OWNER PHONE: 41111 ?4,5'.---/.67 Go( ._.,.... .. OWNER EMAIL_: . .•.. ../M T....,-.. ,�,..m..... .. . .... ... ., .,.,. ..�.. •. <br /> CONTRACTOR NAME: U (! ,AJ 6 roe-re: d G �I <br /> CONTRACTOR ADDRESS: STREET '24 2..-0 = f t� cc() p� <br /> CITY U Y2- ( STATE (/(,/A moo,77 <br /> ZIP p2-0/ <br /> CONTRACTOR PHONE: 4'2-5,2-5 2 -"5/t( • !CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): COR2.4.5S®2..24.17- CITY OPEVERETT BUSINESSLICENSE#(REQUIRED): Q96 r " 5' <br /> • <br /> PRIMARY CONTACT: El OWNER I�CONTRACTOR CI OTHER(Please Specify) ~ z .•_u.•. �+ <br /> CONTACT NAME: CONTACT PHONE: 4 7 5-2.5-2.---,/i 9 <br /> iZC f� S-74- CONTACT EMAIL: <br /> gC>Kcs) _' Mt/a-, Cir <br /> Existing Use of Building: / Contract Price of Work:$ Q <br /> Proposed Use of Building: �Heaf Source; ElGas ElElecfrlc ❑Other <br /> Building Type: FR Detached EISFR-Attached Elbupiex EIMuIfI Family#k of Units: ElCommerclal Cllndusfrial <br /> Type of Project: L7New E(Addlifon QRemodel DRepalr ❑T.h EISfgn E1Sprinkler ElDemoiition QChange of Use <br /> DESCRIPTION OF WORK: C� � l��`� a b "J� (1:1 7d_tL�i re r <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> _ __ _ . <br /> .M... NdcAL 6 BRMITAPP .YCAu l ON 1 . • • . PLUMBING __ . <br /> P8RMI'I`APPLJCATIION - <br /> Type of Project: _New Addn ,Alteration )cRepalr fI Type of Project:_New Addn _Alterafton __ Repair <br /> #of List of Fixtures I #°f List of Fixtures ! #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures j Fixtures Fixtures <br /> A/C—Air Handling Units • Heat Pump ; i Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boller ; ; Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain j <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 /> • <br /> Range Hood <br /> Water Heater i Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.)' Other: 1 <br /> I <br /> : .•SPR9. YKILEA/S•U; >'R SsfOI Y•SYSTEM I <br /> Number of Heads <br /> ACKNOWLEDGEMENT'l have reviewed this application and confirm the information contained herein Is Prue and coned,Work done pursuant to this permit must comply with <br /> :went 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 /> luilding Official before being authorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the work for which application Is made, <br /> nd I comply with the State Contractors Law 18.27RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT 1 <br /> kt.....„1„.‘...„..61714 ic-z —`�- ISI- �� <br /> wner/Authorized Agent signature Date (Revised 5/20/2014) <br /> I <br />