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PERMIT APPLICATION <br /> ,�/� BUILDING MECHANICAL/ PLUMBING/SIGN/SPRINKLER 1 DEMOLITION <br /> Z/ _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> #-Z ..,r'_ . erlW .:ROJECTSITEAtF,,ORMATION <br /> PROJj CT €tDD",.E....0. --,_ ilri4.2_ . 1ROPERTYTAX#: <br /> LEGAL for new construction: Short Plat/subdivision t7'4' Ode) Lot No. (attach copy of long legal description) <br /> : .ai , t;Sd CONTACT INFORMATIONtil, 7., ri}. , v.' s, 4:,id. mprm <br /> OWNER NAME: iN, )e r q( .1 \_ if, t I TENANT NAME(If Commercial):/� i( I8 q irQ,(T-1OWNER MAILING ADDRESS: STREET c��- �5 ) J- <br /> I ^ <br /> 3 <br /> CITY (�tD�' _ STATE INT J ZIP <br /> OWNER PHONE: ,,v, -5-3(1-1OWNER EMAIL:76,04 ni , i..ir c/4i rrGt2. (7 i Q.` c -L.—. <br /> CONTRACTOR NAME: p �ArN - t 1 r <br /> CONTRACTOR ADDRESS: STREET w y v <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE ) CONTRACTOR EMAiL: .----- <br /> CONTRACTOR LICENSE#(REQUI RED): CITY OF EVERETT BUSINESS LICENSE##(REQ R 4\1 .k____ <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR WOTHER(Please Specify) I <br /> 'S -f <br /> CONTACT NAME: CONTACT PHONE: a2:10 � ._C,'7) - <br /> - <br /> --_ F `O )15 E-S4eo CONTACT EMAIL: // G_. , <br /> _ 1._,X <br /> f j n syr.x _ ssm .' , ..._.. .: ..,_. ._vs BUILDING:_efeit 11'IT APPLIotto �t fi_.. ¢ _. .._. ._.�, <br /> . .�.. .. sem..,_..._..._ ' ,r , <br /> Existing Use of Building: Itt.t Al Contract Price of Work:$_____/.0120° <br /> __ ,O <br /> Proposed Use of Building: (-6:=C Heat Source: ❑Gas iSElectric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ElDuplex OMulti-Family-#of Units: *Commercial El Industrial <br /> Type of Project ONew DAddition DRemodel ORepair *T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> rrcg_ ll--e2DvIriLIL--- t <br /> ASSOCIATED B iLDERMIT#(if applicable): (f Of lt`� <br /> " ME0000110#0 10:4PPLICATI . ,gn- `adtti BINE„pEkttitQPPL a. O)ea fa„ ,:' <br /> Type of Project: New Addn Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> Fid of List of Fixtures #of Fixtures Lis . Fixtures Fixtures List of Fixtures Fixtures ist of Fixtures a <br /> 1 <br /> C—Air Handling Units 'eat Pump Toi- Ba ow Preventer(Inside Bldg) <br /> Force. Systems Unit Heater Bathtub •rinal <br /> Gas Piping _ Boiler Lavatory(Wash •'n) Drinking Fountain I <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos- Grease Trap <br /> Gas Range Ducting Dishwasher - :oof Drains <br /> Clothes t er HookupsCM er: Clothes Was Me. Gas h <br /> Ra Hood Water He- -r Other. I <br /> aust Fan Sink •-rvice/Bar/Mop/etc.) Other: <br /> I <br /> t <br /> Y 4011NKI ER0/S.00-0)ONuSYST Mg7 1 <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 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 412W-2Z1-7 e5(71OT— <br /> Ow uthorized Agent Signature Date (Revised 10/12/2015) <br />