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PERMIT APPLICATION <br /> BUILDING/MECHANICAL I 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 1(E)evereffeps@everettwa.gov I www.everettwa.gov/permits • <br /> (4.{te.otr 1Bf ck Mk kinll.eiees©) ' • PR.t JE6Tt'talt INFO::ill/ATIOM •' <br /> PROJECT SITE ADDRESS: go-7 _ / 1/( PROPERTY TAX 4: <br /> LEGAL for new construction: Short Plat/subdtvision Lot No. (attach copy of long legal description) <br /> CON TAd'!I litsllriDi26YiApl tON <br /> OWNER NAME: /{/9 v"( j)-IV _ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: a p sr ,�,J* ,,}�4,7, �J� ( • <br /> gf �, cm' /(�_•../Wren- STATE -, zip el 20! <br /> OWNER PHONE: en1LI / i// OWNER EMAIL: ..,•„...,.....�,.,,�M..,,, ,. .� . ... ,..,,,,. ..._, ,.. ., .�., .,w , <br /> CONTRACTOR NAME: E k/t .6 Old 6 7`1DrT( �at`(EE( Wt 6i' - <br /> CONTRACTOR ADDRESS: sumer '2-1 2a (%C-t iic(lr ' d� <br /> CITY UmY -I { STATE (jt•/y�- TIP i S26/ <br /> CONTRACTOR PHONE: 4'15-.s-'2_-3//14 • 'CONTRACTOR EMAIL: A,Z wLJ / 3ii- i e-. dow,_. <br /> CONTRACTOR LICENSE#(REQUIRED): JUL5` 2 jS p2.V. i !CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C9 tri f,5-5- <br /> PRIMARY CONTACT: Q OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: !� CONTACT PHONE: 47�`e.2-s'2.,J/9 <br /> CONTACT EMAIL: <br /> t • �[TI)LAt1V�PRNii�'APP�li�AS'I®Cd • <br /> Existing Use of Building: ! Contract <br /> Family Priceof of WUnits:ork:$ IQ � r <br /> Proposed Use of Building; (Heat Source: E(Gas IfiElectric ❑Other <br /> Building Type: CISFR Detached OSFR-Attached I-1Duplex L7Multf # 'Commerclal Ef industrial <br /> Type of Project: Cf New ❑Addition LIRemodel ❑Repair 0.1. DSlgn i iSprinkier DDemolitlon E(Change of Use (-7-c(.90.. .--- <br /> � <br /> DESCRIPTION OF WORK: -T iOg 1—€.--(aS ) loss Spt 1 4- Sysrt-s�' (t) I e. gioax- ._ � vt..- <br /> 496 c Fo 0. .lhGar✓ w <br /> t cc , ev, tc c-r5 co a WLtocco-re 5 to-) LuA 2Cja.a-est <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :_ .MECG4;�INICALPRMJT APPLICr•TION . • • . PLUM6ING PEigIVil c'APPLICATION • <br /> Type of Project: New Addn Alteratton Repair i I Type of Project: New Addn Alteration Repair 1 <br /> #of List of Fixtures #°f List of Fixtures ! #of List of Fixtures #of of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units ' 2_ Heat Pump . , Toilet Backflow Preventer(Inside Bldg) I <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Heater . Refrigeration Shower Floor Drain <br /> Gas Fireplace 7 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 /> ' . .' Ii JNKL,l R/S pn's I®R9 SYSTEM <br /> j 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.!am the owner,ori am authorized by the owner of tb/s properly to perform the work for which application Is made, <br /> and I comply with the State Contractors Law 98.27RCW and 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> 14/ /`9_iq PEW \6b ` ' Cf <br /> )caner/Authorized Agen Date (Revls d 5/2/2098) , <br /> . <br />