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,d'-'1"2"--.r BUILDING-,MECHANICAL/PLUMBING I SIGN l SPRINKLER i DEMOLITION • <br /> - cifY OF EVERETT PERMIT SERVICES <br /> T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I ;Nww.everetfwa.gov/permits . <br /> (..046',6i I tack M ®.n[3l.l�1® e) ' . Pt it.JE T tit`Ii• III4FORMATIO1 ••. . . <br /> PROJECT SITE ADDRESS: 3 2 et:.(t.,‘.i /�.ve PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CCIkMilAir.Itilo4lRT>(®IM <br /> . <br /> OWNER NAME: 132E t�L 1,.,4-4 r tcA-n} TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 1----, <br /> Z; (-0 LK,�.)v n ;,°" / ` <br /> coy t--t>LtZ•Gt STATS (iic) , ZIP ,57./Y ' <br /> OWNER PHONE: 14- L 1S2-- 7516)1_... IOWNER EMAIL: ft.,. ..,.. .. ..r.,.., .�.. <br /> CONTRACTOR NAME: �EU .ZMAJ ~6'fl -`Ter $'Ie-e,( 04,61-Pre.. <br /> CONTRACTOR <br /> t12 - <br /> CONTRACTOR ADDRESS: STREET 2-('2,0 6 1 A O tg.gip! 'y ()War STATE WA- ZIP @y trX p� <br /> 24/. <br /> CONTRACTOR PHONE: 4'2-5.-2-5 1.-5(I(.f • (CONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED): E 061265S®',z.p T- CITY OP EVERETT B=NESS LICENSE#(REQUIRED): &a 6 4 5" <br /> PRIMARY CONTACT: ❑OWNER MIXCONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NAME: CONTACT PHONE: 4 Z 5.-7-5-2 w,il <br /> I cites. - —CONTACT EMAIL: s i,,,...44 — , /?4 it/GL..dot/ <br /> „ i3OI1LlifNGeI t MIITAOKidATtO • • , <br /> Existing Use of Building: I Contract Price of Work:$ .54790a`/ <br /> Proposed Use of Building: Nk•(4. - Heat Source: 156as ❑Eiectric ElOther <br /> Building Type: EISFR Detached CISFR Attached 0Duplex C(Multf Famify#of Units: commercial °Industriai <br /> Type of Project: ONew DAddiiion ❑Remodel *epair ❑1.1. ❑Sign i7Sprinkler ElDemotition °Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#t:(if applicable): <br /> 11/11E RAlkilICA.L PMRMIT AOPULliCATIONP+l,UM6I CG OlEglifilIT AI PLIiC.A` ION <br /> Type of Project: New Addn Alteration Repair 1 / Type of Project: New AddnAlteration _Repair <br /> #°f List of Fixtures List°f List of Fixtures ' #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Unifs ! Heat Pump ! i Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal ' <br /> Gas Piping I Boller 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 I • <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc,) Other: <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•l have reviewed this application and confirm the Information contained herein Is true and correct.Work clone pursuant to this permitmust comply with <br /> :urrent federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must fist be authorized In writing from the <br /> 3uiiding Official before being authorized under any circumstance.I am the owner,ori am authorized by the owner ofth/s properly to perform the work for which application is made, <br /> nd 1 comply with the State Contractors Law 18.27 RCW and 2se.200A WAC. <br /> City ofEVerett Official Use Only <br /> PERMIT# <br /> 12,-t i-- t I VVi 1,912 OGG <br /> weer/Authorized Agent Signature Date (Revised S/20/241) • <br /> 1 <br />