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• #1111P . PERMIT APPLICATIOI I' <br /> BUILDIN G ) MECHANICAL/ PLUMBING /SIGN J SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> '� � �y'� "b y <br /> (Blue nor Bieck :61- 4 PI.4a - <br /> PROJECT SITE ADDRESS: 312.1 Rvcicr R Ave PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . ,�a f ` CF NTACT INPC/R bT1oN <br /> OWNER NAME: TVNe. EVttreA %.N;C TENANT NAME(If Commercial): The. EJCye}r C Ir n i G <br /> OWNER MAILING ADDRESS: STREET -5‘A0,,L11 Irk o�k Ave. <br /> CITY Everekk STATE tn1 ZIP 618 <br /> Z 0 1 <br /> OWNER PHONE: u25- 251 - 111c0 OWNER EMAIL: MKi(% b&l;h@eVGYG 'cI,niG , co • <br /> CONTRACTOR NAME: UVs%VtVS%iv) Mec(n a n i ca/ Co, 41rac•f'o I s <br /> CONTRACTOR ADDRESS: STREET Welk 46% la• pI0.CC (Jet k. <br /> CITY NA V..41+0 STATE 0 R ZIP qv Z 1 4 <br /> CONTRACTOR PHONE: 2S 3 -(310 • q O.3'O CONTRACTOR EMAIL: ‘45?-%; k\Q.k I Q UO^C I • cC o Vn-• r <br /> CONTRACTOR LICENSE#(REQUIRED): UN) IVML43931CJ9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (0`72fo <br /> PRIMARY CONTACT: 0 OWNER IcI'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 5r%&b.% M(k-c ln.t.1I CONTACT PHONE: 253 - /O -70 - 9 0 ef-0 <br /> CONTACT EMAIL: 1ot." c O n, <br /> Existing Use of Building: Contract Price of Work:$ vet,Clot 2.0 0 <br /> Proposed Use of Building: Heat Source: ❑Gas RIElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: rgkommercial El Industrial <br /> Type of Project: El New DAddition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Re.rovti ( geelacc ftTU-3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALF!TP:SRM #PP tNtt N ai ry xs .,..a . �.. " 0:01#E , �4AP ► r w <br /> ,., PLU;IilIB1 LISA <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> 1 A/C-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 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 /> iSPIr1,NKLER/SUP RESSION SYSTEnn <br /> Chemical or Water I 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 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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City <br /> (of�Everett Official Use Only <br /> PEf3AlJJ1 %l�.JICtiCCIG <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />