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PERMIT APPLICATION <br /> OLTBUILDING ! 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)averetteos@everettwa.gov I www.everettwa.gov/permits <br /> (Blue ar'Black Ink Only Please) 'PROJEGT•SITE r 1_= ', <br /> . tr��t�.�tMarlai� �� �; <br /> PROJECT SiTE ADDRESS: 1 I ( 1..,.1 CI}_ 1 arta TY PROPERTY TAX#: <br /> LEGAL for new const action: Short Platlsu6divtsion Y� / <br /> ----- ._ Lot No. (attach copy of long legal description) <br /> CONTACT''INFORMATION ' <br /> OWNER NAME: 7)`'CV 04 & ma ,ti, TENANT NAME(IF Commercial): <br /> 4 " LYI.e�,,,, .. <br /> OWNER MAILING ADDRESS; srsr.. t Hi 911 -- <br /> I a41 ci DrCITY t7f,r s <br /> OWNER PHONE; L" r} r jt Q5 -3 3 � OWNER EMAIL: <br /> CONTRACTOR NAME: n i - <br /> CONTRACTOR ADDRESS: STREET t'L.}� C.- <br /> CONTRACTOR , dct7 t <br /> ,iY ,/.Sr•i �/l�./l! STATE A-- Z', 20 1� � r...4J <br /> CONTRACTOR PHONE: 42.5 2,, tt o5e0 CONTRACTOR EMAIL QI (...2 , c-i1vu.Gjf in .Com <br /> _ CONTRACTOR-LICENSE4/PEOUIRPD): '. O7r" R- t .___,CI'T'Y-OF EVERETT BUSINESS LICENSE#(REQUiRED)' -I Dip 9 g <br /> PRIMARY CONTACT: ❑OWNER LSCONTRACTOR ❑OTHER(Please Specify)_ <br /> CONTACT NAME: CONTACT PHONE: .6 2_5(3 (:) 5-0 <br /> Totolo LL <br /> CONTACT EMAIL: jak)a c kea,, V)Lj .Co f <br /> e <br /> Existing Use of 3uIldin,: Contract Price of Work:S _ <br /> Pragapserl Use of Building: : a � -------.. ..__�,. <br /> Heat Source: `-"'teas ❑Electric ❑Other— <br /> Building T pa: ;r/S R-Detached ❑SFR-Attached ❑Dunla.x ❑Muitl-Famll 4o Units: <br /> ❑Commercial ❑Industrial <br /> fiype of Project_ ❑New ❑Addition ❑Remodel ORepair ❑TI, ❑Sign 050rinkier ❑Demolition ❑;hsnge of Use <br /> DESCRIPTION OF WORK: <br /> e1f4l C2 GAS -c-142naciZ—. <br /> ,ASSOCIATED BUILDING PERMIT#(if applicable) <br /> MECHANICAL PERMIT APPLICATION "�"�"""� -- <br /> I~* t1MB N '�' RM 'tAI�,P,LICATIt t ---- <br /> Type or Project: New Addn Alteration Re air <br /> #of p Type of Project: New _Addn _Alteration Repair <br /> U&:t. iLfuttes__ #df #of <br /> fzfvres.. ttx!(Ttn Etat otlxlcrres .. 6irtflf, 1eS_ __. #of —._ <br /> txtvras L- of-Futures <br /> A/C—Air Handling Units Heal F amp Fixtures <br /> Forced Air SystemsToilet UrinalBackilow Preventer(Inside Bldg) <br /> Unit Heater Bathtub <br /> Gas Piping <br /> Boller Urinal <br /> Water Heater ShowLavater (Wash Basle) Drinking Fountain '--" <br /> tRefriger�tlnn Shower <br /> Gas Fireplace Wood Slcve Floor Drain <br /> Gas Ran e Kitchen Sink&Disposal Grease Tran <br /> g Ducting Dishwasher <br /> Clothes Dryer Hookup, Other- Roof Drains <br /> Range Hoad Cloths Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mopfetc.) Other: <br /> SPR1tJltLEt7'l5UPPRES5tOt1 SYSTERiI <br /> Chemical or Water No. 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 <br /> Building Official before being authorized under any circumstance.I am the owner,o 1 am authorize ations by t the owneerrefrom.of this property to perform theDeviations must firstework forZwhiin writing <br /> ch applicc tions its made <br /> and I comply with the Slate Contractors Law 18.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Oil,• <br /> :ALS U 1 PERMIT* t f g[ <br /> Ow"erfAutflorizadA e � , <br /> Age Signature S2 <br /> ' C3ia ' (Revised 9/23/2016) r <br />