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4:1:, PPRIiIIIT APPLICATION
<br /> B IJILDING i 1VI CHANIGAL I PLUMBING/SIGN I SPRINKLER/DEMOLITION •
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201 .
<br /> (P)426-257-8810 i FAX 425-257-8857 i(E)everetteps@everettwa.gov I ;Nww.everettwa.gov/permits
<br /> ( iii 'orisin&c ink®.[ivpIe e) PRQJE©T�ii4 a INFOfminflO ,
<br /> PROJECT SITE ADDRESS: „Ty')3 /7 /////J/) Zi ,PROPERTY TAX#/: I
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> I' • .• . ' ..coNTAcT.liwFo9tVNATIO?1► . _ . • ' ' _ . . , •
<br /> OWNER NAME: 1(I t/Lf/c F/ivA 12(c 4pyiex-✓/ TENANT NAME(if Commercial):
<br /> OWNER MAILING ADDRESS: STREeT ¶ (.gj /*;/Y/n1ut> ; •
<br /> ony (AVL• STATE Lt 4, ZIP 'ZO 3 ,
<br /> OWNER PHONE: '4O,4a ..e / — !�., OWNER EMAIL:,..,. ... ...,.,. e. ,.., ,. �.. ... ,..
<br /> CONTRACTOR NAME: E U ad,•G( ok..) 6TA-7-1( c m6
<br /> CONTRACTOR ADDRESS: sTREST '2-(20 ' t pct. Au er
<br /> clrt •G'UM:51 r STATE tit}4.— zip ` C32-0/
<br /> •
<br /> CONTRACTOR PHONE: 4-2,5,2.5-2..0-5 j/4 . 'CONTRACTOR EMAIL: g -A_5. ),,e s'S/0 a%€, G C14.4 '
<br /> CONTRACTOR LICENSE#(REQUIRED): C(1t 5S&2.�r? f CITY'OF EVERETT BUSINESS LICENSE#(REQUIRED): t]6 e .. rPRIMARY CONTACT: Q OWNER aCONTRACTOR 0
<br /> OTHER(Please Specify) a...., .,.._....,. .... , h.~ .. ..,,.. .
<br /> CONTACT NAME: CONTACT PHONE: 4 7 5..2.5-2-,//9
<br /> a1 J C7ti4LD CONTACT EMAIL:
<br /> >3IJI1,gipNG FERIWITAPPLJCAtiOi • •
<br /> Existing Use of Building: ! Contract Price of Work:$ 'i JO* . -�
<br /> Proposed Use of Building: Heat Source: *as E(Electrlc °Other
<br /> Building Type: FR Detached °SFR-Attached [Duplex ❑Muir!-Famiiy-#of Units: °Commercial ❑Industrial
<br /> Type of Project: °New °Addition °Remodel °Repair °T.I. ESign °Sprinkler °Demolition °Change of Use
<br /> DESCRIPTION OF WORK: �i-h►s�1:� 0„_.,,, 5et„1 v 5 ra,, ,L' , J/,_l ,„r5, i4v4 - .
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> • ' :McHANtcAL P .RP/11T PPLtCAUON . • , PLuiviidukte Ota Mint APPLIICAT1IOFt
<br /> Type of Project: New._• Addn _Alteration Repair I Type of Project: New __ Addn Alteration Repair
<br /> #of I List of Fixtures #of List of Fixtures ! f ' °f List of Fixtures ; #of List of Fixtures
<br /> Fixtures Fixtures j Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump ; 1 Toilet 1 Backflow Preventer(inside Bldg)
<br /> Forced Air Systems Unit Heater i Bathtub Urinal
<br /> EMI Gas Piping , Boiler I ; Lavatory(Wash Basin) Drinking Fountain .
<br /> Water Heater . Refrigeration , Shower 1 Floor Drain
<br /> Gas Fireplace 7 , Wood Stove Kitchen Sink&Disposal : Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains •
<br /> •
<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 /> . :•ElFi.i*.na.Eiki .Il9PAIMOtt9•sy' �'EM i 1
<br /> I Number of Heads __
<br /> 4CKNOWLEDGEMEN7.•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 /> :urren€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 /> Iuilding Official before being authorized under any circumstance.i am the owner,ort am authorized by the owner of this property to perform the work for which application Is made,
<br /> nd I comply with the State Contractors Law 18,27RCW and 296.200A WAG.
<br /> City ofEverettOfficial Use Only
<br /> / , P z.-—�5�- i PERVII l \Z I
<br /> wnerlAuthoriz d Agent Signature Date (Revised 6/20/20/8) .
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