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• <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING 1 SIGN/SPRINKLER/DEMOLITION • <br /> se. -.741._ <br /> F# _ _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 426-257-8857 I(E)everetteps©everettwa.gov i www.everettwa.gov/permits <br /> (U'.I.ue'or stack filk kinI7 Weeks) ' : ' PRQJECT tii.'t INFOft IVIAif1ON ..• .. • . <br /> PROJECT SITE ADDRESS: /� �/� <br /> 'ZZZ�I°-QL��/-�,5 /-I�!'t. I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivislon Lot No. (attach copy of long legal description) <br /> - . . • • • ' ..CO,N�'AdT I IFORIVIA 'I® I , . <br /> OWNER NAME: Aed c-I-on — TENANT NAME(If Commercial): _ <br /> OWNER MAILING ADDRE S: STREET V2-23-1 Oakes.. Ad's• . <br /> CJTY a`L'1Z°-.* STATS kik] �y A zip 4 �5 2C 1 <br /> OWNER PHONE: 21363-35(0-025 2 OWNER EMAIL: N/A <br /> CONTRACTOR NAME: E U2.L A) 67-74-7-1 fft ' 6ii- <br /> CONTRACTOR ADDRESS: STREET '2--I'J 4)�g PA•Gt J M./fr p��9.. <br /> Cn? �✓V CYW{ ► STATE (,414-. ZIP i tagOt' <br /> CONTRACTOR PHONE: 4.15.2.52"5/14 • 'CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): (,L-srd..6 jS 02.24 T. low OF EVERETT BUSINESS LiCENSE#(REQUIRED): G9 611,5-5' • <br /> PRIMARY CONTACT: El OWNER iCONTRACTOR CI OTHER(Please Specify) - <br /> CONTACT NAME:�/_ - CONTACT PHONE: 4 2 .5-2-51 . //9 <br /> l� -s'` i CONTACT EMAIL: <br /> Vane essr,1 wa. (w n..► <br /> Existing Use of Building: <br /> BLJILI]IIVG iPRIGi[1'APPL.i��►`I'((®N ; <br /> i Contract Price of Work:$ 3.200Proposed Use of Building: Neat Source: C1Units:Gas lecfrlc [(Other Type: I$�SFR Detached °SFR Attached °Dupiex °Muhl Family#of [(Commercial °Industrial <br /> Type of Project: °New °Addition °Remodel ❑Repair Z.I. DSIgn [(Sprinkler °Demolition [(Change of Use <br /> DESCRIPTION OF WORK: <br /> st�11 d�+1QS5 t ,*- QU./Y\p S5S- , <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :kittifAI IOAL.P RIVII`1`APPL.ICATW I . - . PL.UMVI131NG PaRMI14APPL.IICATIOII • <br /> Type of Project: _New Addn _Alteration_Repair Type of Project: New __•Addn Alteration ,_Repair 1 <br /> #ofList of Fixtures #°f List of Fixtures #°f List ofFixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping 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 ' <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(ServIce/Bar/Mop/etc.) Other: <br /> :'SPI JNKL.El 1 SUPPRs5S1OM SYS 'EM <br /> (Number of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the Information contained herein Is true and correct.Work done pursuant to this permitmust comply with <br /> current federal,state,and local law.The.ranting of a permit onlyauthorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Offici•'l before being aut • -d u der any circumstance l am the owner,or/am authorized by the owner of this property to perform the work for which application Is made, <br /> and l mpiy Ith the State : tractors L:w 18.27RCWend 296..200A WAC. <br /> City of Everett Official Use Only <br /> ' jPERIoo <br /> Own /Authorized Agen CT tura 77 e (Revised 5/20/2016) <br />