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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION <br /> /1*Yr--.A 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@everettwa.gov 1 www.everettwa.gov/permits <br /> kr' t i z ,:,-., 1 01(01 R TIQ a i P all6 <br /> PROJECT SITE ADDRESS: L 7-L. ]�^'� ., !� PROPERTY TAX#: (JO t /'I- 0r1 Q 1�/`i/' <br /> LEGAL for new construction: Short Plat/subdivision(/ /dV Lot No. JO <br /> (attachbcopy offllong legaldescription) <br /> Vasgt- l �" . 00. A NF�O �AIONr ' '7 �i <br /> � " g��� „5 <br /> t--t � <br /> OWNER NAME: � tk � <br /> LoP€7, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 'r,L4. VV"\j ke, <br /> CnY EverC/1 J YYYY"��""`` STATE'JJ ZIP /D`�/ <br /> OWNER PHONE:M(2—�Q6-(46132 OWNER EMAIL: ick la <br /> J an- re yid .ag► i .(/1(6 <br /> yn <br /> CONTRACTOR NAME: IUC 4 0 <br /> CONTRACTOR ADDRESS: STREET 1l` l /iO 3-1 SW <br /> --����� ?F <br /> CITY v --ri /C/ STATE 'l ZIP l$ <br /> CONTRACTOR PHONE:LC ii <br /> CONTRACTOR EMAIL: 1--ii al' /✓ `V j, #as w I ag <br /> CONTRACTOR LICENSE#(REQUIRED) �U Cp—l—�'7 ,1�J CITY OF EVERETT BUSINESS LICENSE#(REQU ED):052-lir <br /> PRIMARY CONTACT: 0 OWNER tat ONTRACTOR 0 OTHER(Please Specify) <br /> CONTA T NAME:Y CONTACT PHONE: LIZ _-7 L— V <br /> M�1 A ill. 6 -e CONTACT EMAIL:1(i . I AP' I /e[ ry-l�,U� d/ i't. ( I— <br /> " " V <br /> 7. t B 1 DING PERMIT?APPLICATION " <br /> tee � — <br /> • <br /> Existing Use of Building: �� Contract Price of W. .$ L . <br /> Proposed Use of Building: Heat Source: ❑Ga• El Electric ❑Other <br /> Building Type: IFR-Detached ❑SFR-Attached �D❑Duplex ❑Multi-Family-#of Units:' Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel l�t4epair ❑T.I. ❑Sign ❑Sprinkler !iemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> \\\Le- al U110 ee, c nq CO- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MEBHANICAt,PERMIT APPLICATION g ,' , , . g;PI o:NiB,ING PER VIItrAP L CATIOOWA V,: <br /> Type of Project: _New _ Addn Alteration XRepair Type of Project: _New Addn Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> k Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping 1 Boiler 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 /> T �;�S,PRIN LER�%S AS(000,N1Sl( SBM "'' <br /> ,�a .. .a e„ a 'r,M u 6 ie 'lu n.6d t <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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> i � Il� ti , P ioS . D29 <br /> er �c nt ature Date Revised 10/12/2015 <br />