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''I PERMIT APPLICATION
<br /> BUILDING I1f1CHANICAL/PLUMBING/SIGN / NKLER/ DEMOLITION
<br /> #111 --1 CITY OF EVERETT PERMIT SERVICES
<br /> r 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 /> -.. .. a'PR. EC , E D ORMAT a;,
<br /> u liW ii
<br /> PROJECT SIT DDR SS: d'14 PROPERTY TAX#: ooa 00000 tZ OO
<br /> 0500 FV GEtSN W�.Y SU\rGS -�s.{
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) ikil L UD
<br /> t,„ ,...... i; -`" rW t .E €€iii..l GQNTAtT INtt'1 MA 1-. , ~. A s ,
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<br /> OWNERR NAME: AG (KNE j'CMN�Ej I NC' TENANT NAME(If Commercial): -3M(..- ACS INT �
<br /> COVNERMAILING ADDRESS: STREET G 410 UyE�o �� r k)licy 3T0 �0D
<br /> • l \)� �C \ CITY V 5R_�j y 1 1.- STATE w A ZIP ' LO
<br /> OWNER PHONE: q'ZJ—a1J'-'—Z� ? 1 OWNER EMAIL: She&O * q7 gcr,.aa9! cOm
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> •
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR MOTHER(Please Specify) /Klan Mcl-
<br /> CONTACT NAME: evArck1E1.4Z, %-NE� CONTACT PHONE: 20E- 7b2,- 23 1 L'
<br /> CA, AibE1Z_SO1J A'0R CA I'muS CONTACT EMAIL: (iak)(_, ,C..130‘,— (krGirl•COM,
<br /> t', ,y. 1, , :._.,_. 5, G! aH01NG..,.: , _. nip ., , TI .. cam,„,„ . , ni14 Pig§44
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<br /> Existing Use of Building: MI-AIL Contract Price of Work:$, � V vw-^ 2510003.,.
<br /> Proposed Use of Building: p.. ,tL tFIkkateltedete Heat Source: lEr.Gas ❑Electric ❑Other
<br />• Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: aCommercial ❑Industrial
<br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair EfT.I. ❑Sign OSprinkler ODemolition ,I Change of Use
<br /> DESCRIPTION OF WORK: ('re >4-103: it ==per Qt-tAll- 1ACi'r\--)0►J rot- SOVYgAl a-0 • 0.)0V,) -
<br /> SCTA -.)QAt- WO 100 CAOck)6b OV- 4.5 •
<br /> 1,,f,..- 1 _ . • - - _ ! ' ".�• f ► ,... . 1 _ 4 t — ' . . , — .. r
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): • - • lip • • . _ — - — -
<br /> I Maw CHANICA .
<br /> t - —'• PPLICAT10IC _.; ;, ,..�,.,. ,3rPLUMBI1!!OIWOA,pPLICATii704CP
<br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn XAlteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> ,
<br /> A/C—Air Handling Units Heat Pump N Toilet -¼ 4' Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtu ee100-4-.:5/1(141.‘ Urinal
<br /> Gas Piping Boiler Lavatory(VC/Ash F, sin) `Y 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 /> Y '•
<br /> Mk 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,st-te,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 Offic•I,efo, being authorized under any circumstance.1 am the owner,or lam authorized by the owner of this property to perform the work for which application is made,
<br /> and I comp,/ thState Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
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<br /> r _
<br /> 2/3/16
<br /> PERMIT# 1 IUOA.-0i-7
<br /> •, ner/A 'h.rized Agent Signature Date (Revised 10/12/2015)
<br /> (,,,....\12.)
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