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• <br /> PERMIT APPLICATION <br /> BUILDING/11i1ECHANICAL I PLUMBING 1 SIGN/SPRINKLER/DEMOLITION • <br /> .t41:617' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@averettwa.gov( www.everettwa.gov/permits . <br /> (lilue•ter iia k Itiic etrahri lease) ' : PII®JECT skit INFORMATION •• •• <br /> PROJECT SITE ADDRESS: I 40 lfrtebtze64L 4 ( )PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision UU Lof No, (attach copy of long legal description) <br /> •. _ ..COI�ITAACT.ik IFCikl>AAll®kti . '. . •.' . . . .. . <br /> OWNER NAME: 0...k p, Ai _ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: snisr `74.f•.� 1/14 ' J, -.,. / <br /> CITY 1ml STATEZIP �" , <br /> OWNER PHONE if Ai /. OWNER EMAIL: <br /> 4,,.. - s�aniSiT..:6o•.. <br /> CONTRACTOR NAME: E U� n._64. - n.r 4._, i.. ..6. ..T.... Irs:.r. .-.n t`1E..•.a•.1/1nrr2&.»r7cn. - <br /> CONTRACTOR ADDRESS: STREET -�Iv"4 O Ac...)pjTY a V <br /> aril- STATE toll 4- ZIP etG2o <br /> CONTRACTOR PHONE: 4`z5.'a.c 2.,./ //4 • CONTRACTOR EMAiL: k/, V - ,J/rit Gt.,2, (-cu.�. <br /> CONTRACTOR LICENSE#(REQUIRED): E() (.3s c)22,0 1.- CITY OF EVERETTBUSINESS LICENSE#(REQUIRED): 0 6 r s- <br /> PRIMARY CONTACT: 0 OWNER 1 .CONTRACTOR 0 OTHER(Please Specify) ' <br /> CONTACT NAME• / CONTACT PHONE: 4 7 5--2-5-2,--j/r 9 <br /> /C(�—' &--c CONTACT EMAIL: V.e i k <br /> _ . • ' '. BUIL) INP$PtRtVII i`APPLICATION <br /> Contraci Price of Work:$ f.X Z <br /> Existing Use of Building: I t <br /> Proposed Use of Bu!ding: Heat Source: ❑Gas ' lecfric ❑Other <br /> Building Type: 1 FR Detached i�SFR Attached QDuplex ❑Multi Family of Units: ClCommercial Ellndustrial <br /> Type of Project: °New ElAdditton °Remodel ❑Repair IaT.I. °Sign °Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if pplicable): <br /> .: : :M•BCI A NIcAL PERMIT AAPPLIcATIONN 1 . • • • . PLUfl/LBINO PERlifiIT APPLICATION • <br /> Type of Project: _New Addn Alteration_—Repair Type of Project: New _Addn )iteration •_.,Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures , <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC—Air Handling Units ' Heat Pump Toilet -Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower ;—Floor Drain . <br /> Gas Fireplace 7 Wood Stove —Kitchen Sink&Disposal _Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Mil Clothes Washer _Medical Gas • <br /> Range Hood ' : ' '- _Other: <br /> Exhaust Fan =Sink(Service/Bar/Mop/etc.).=Other: <br /> •BPRi;,9r(LIE /.611.PPRB0Si®R9 SYSTEM '_ '_ <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,ori 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 18.27RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> lg-ti I PERMIT ] sm......0L <br /> q <br /> Owner/AuthorIzed Agent Signature Date (Revised 5 0/2016) • <br />