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i <br /> PERMOIT APPLICATION <br /> '�" BUILDING I`MECHANICAL/1 PLUMBING I SIGN I SPRINKLER 1 DEMOLITION <br /> etyy OF EVERETT PERMIT SERVICES <br /> _. <br /> a a 3 CEDAR TREET,EVERETT WA 982U1 <br /> _... - s - i °.t" 7 1(E)-ayarattapaataverettwa.gov t wWwieverettwa.goviperrnits <br /> Y � <br /> PROJECT SiTE ADDRESS: P c' ,. .„ :" PROPERTY TAX* <br /> LEGAL for new er a *t° Lot No. (attach copy of,long legal descnption •) <br /> a <br /> : m — 3 . v <br /> . �;� I .1E o _ s <br /> OWNER NAME: o let"°°- TENANT NAME Of Commercial}, <br /> OWNER MAILING,ADDFSESSa <br /> z , <br /> OWNER PHOli 5 3 OWNER EMAIL`/ 4 <br /> � <br /> CONTRACTOR .:4~< -- ° -• t r' ,. .. i ° -.,„r: i : <br /> CONTRA c O *DD sem, - s_ , 1,,:) - <br /> ar L . ` kt „, \ t STAlE <br /> CONTRACTOR "LA 0 - CONTRACTOR EMAIL s b- 4 t `t „ h - <br /> CONTRACTOR LICENSE#(REQUIRED) ( ' 1,ITY orevERETTSLimoN a €--7'‘ 0 —i <br /> PRIMARY CONTACT: E1 OWNER O CONTRACTOR O OTHER . a <br /> (f'3e Specify) <br /> CONTACT NAME: CONTACT P'HOiiiE. <br /> " ,— -5 4.4 4 <br /> s CONTACT EMAIL. <br /> Os4c cc.�. t i t <br /> , <br /> Existing Use of Building: Contract Price-of Work:$- t <br /> Proposed Use of Building: Heat Source: Chas Eleoma OOther <br /> Building Type: `LFR-Detached USFR-Attached UDupiex OMuIti-.Family-#of Units; O.Commercial Uindustriai <br /> Type of Project:; ONew OAdditian ClRemodel ORepair CIT.i. CiSign OSprinlder [!Demolition 0Change of Use <br /> DESCRIPTION OF WORK: <br /> N, t�<\ c' ,rte � t' t, C,4 - k, .(.. <br /> ASSOCIATED BUILDING PERMIT#(if applicabie): <br /> '..', 10:04-1-0*. <br /> jj y r <br /> Type of Project New_ Addn Alteration_Repair Type of Project: _, New Addn Alteration _Repair• <br /> #°f List ofFbrturea #of List ofFxtuMes #of list ofFlxtures #of List offlxiures <br /> Fixtures Fixtures Fixtures: Rxturea <br /> NC—Air Handling Units Heat Pump Toilet Bacitfldw?reverter(inside Wig) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> as Piping ;Boiler La story(Wash Basin) Drinking <br /> {GFountain <br /> Water Heater Refrigeration. Shotr ,Floor`Drain <br /> Gas Fireplace Woad Strive kitchen rSink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups': Otter ClothesWasher 'Medical Gas' <br /> Range Hood Water Heater Other. <br /> Exhaust Fan 'bink(Service/Bar/Mop/etc.) Other: <br /> .w�, ,. ,� p..._w ....��� .a.. <��.,. <br /> !Chemical or Water No.of Heads <br /> ACKVOWLEDGEMEi+NT•I have reWewed this application and confirm the Miorinationon contained herein'shim and correct.Work done pursuant totters pemat must comply with <br /> current,federal state,andlocal law.The granting of permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized In writing Maratha <br /> Building Official before being authorized underany circumstance,l,am=.the owner,or am authorized bythe woof a th%spropefly to perform the work for which application to made, <br /> and t comply with The State Contractors Law 18.27 RGW and 296.200A WAC; <br /> City ofEvorettOffkJal Use Only <br /> 1 I (in c...wka-,..., i 0 -1 - ( .e.- <br /> C , <br /> El\T-4 \,?, 0 - 0 --k-O <br /> Owner/Authorized Agent !nature Date !Revised$/2312016) <br />