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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 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)evert ttepseeverrettwa:ga v I www.everettwa.gov/permits <br /> (E1ul '} +'BOatcki tlfkai y.,l ieiti tet k'i.RO J " i .sm NF�• >� <br /> PROJECT SITE ADDRESS: <br /> LEGAL for new construction: Short Pietist! PROPERTY TAX#: <br /> bdivision, Lot No.' (attach copy of long legal description) <br /> cONfiA471 I'CIN' Qr <br /> OWNER NAME <br /> 14L40 1,06) `.. TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY ' - • _. w - <br /> STATE } <br /> OWNER PHONE: ZIP d - <br /> Sig f J <br /> - OWNER EMAIL; <br /> CONTRACTOR NAME: rill inc. <br /> CONTRACTOR ADDRESS: STREET <br /> _. . CITY -.: fi 4e. • ',. STATE ' '. " <br /> CONTRACTOR PHONE <br /> ZIP <br /> .�.,� <br /> Q CONTRACTOR EMAIL, <br /> NAS <br /> ter, <br /> PRIMARY CONTACT: 0 OWNER tircONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 9 <br /> CONTACT EMAIL or a 0,„,onhe GOlit <br /> vi <br /> Els#itt ^Use of Building:x' F ,. ,. �, <br /> Contract Price of Work:$ Z," /',f <br /> f fo00eell Use of Building <br /> Heat Source: as ❑Electric C/Other <br /> i3tiltditiJ Type: FR- tackled ❑SFR-Attached ❑Duple t CIMut Famfty-#of Units: ❑Commercial ❑Industrial <br /> 14.. of Pro sat; ❑New OAddition ❑Remodel ORe.atr° DTI. OWlen 0 ®riottier°, <br /> ODemolition C ✓hanme of Use OFIA/RK; nef(�^A. Q S rnaCaS .¢ # r �, <br /> i , <br /> ASSOCIATED BUILDING PERMIT#fIliapplicable): , <br /> MECH 9tNIcA1.,PERMIT APPUCATION..' j �. <br /> �'`.� �sl�� l +f+�'�� 1�14���s�1�C� � r1`1t71� <br /> Type of Project: New` Addn !Alteration _Repair T <br /> #of ' Type of Project: New _Addn _-Alteration Repair <br /> It Af Fxt"tttes #of _ <br /> #of <br /> Flxture8 z fes" btu a Fixtures lE lltfu a& Fixtures I LTsf f�tcr> <br /> A/C'-Air HandlingUnits Heat Pump Toilet <br /> ,- SackfouPreventer k�sfda RigForced Air S ferns Unit Heater -Bathtub Urinal - �. <br /> � <br /> `'as Piping o ler � � Wavat, iWash'Basin <br /> Floor <br /> Drain Fountain <br /> frl <br /> i Water Heater Refrfptjon' � . Shower <br /> Gas;Fireplace. Wool!Stove` Floor <br /> Gas Range Sink Disposal: Greer _ <br /> 9 Ouctitt9 Dishwasher <br /> �Trap <br /> Clothe l rtfel Iiaokups "� „ Other: Clothes Washer - orf Drains <br /> Range Hood -Medical <br /> Exhaust Fan Water l`teatea O <br /> thea. <br /> Sink.fServicefBar/ Mestc, Others <br /> ' RrSION SY TEM <br /> !Chemical or Water j 1No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein/s 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 lam authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> .y of Everett Official Use Only <br /> PE I # <br /> 1°,414 I 6 _ 12.2g .1 <br /> — — <br /> 0' ,°r/AdUYibrt2attAir Signature <br /> Date';', -ow::ea 9/2312016 <br />