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PERMIT APPLICATIC <br /> ',IABUILDING/ 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)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue„or Bl Ogi,4n.k`Only,l ilii ) PROJECT SITE44#0RMATION, ,'' <br /> PROJECT SITE ADDRESS: G 'd 3 A5ex.. 1"C/4✓ +0,(.. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ia r •r*,, ,, ACT A 1N!r Mi i . IMt,- axiti Ai L <br /> OWNERNAME: DA.&4:f...-( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET0 <br /> 63 3 Aqac,,„4,4,/fir Aote- w✓ <br /> \ CITY l�A"G” / STATE -I "I ZIP 18''2.03 <br /> OWNER PHONE: (z,°�+)S0,- ?930 OWNER EMAIL: e/130(rHcrj/G.)a/hq�r/Cosy <br /> CONTRACTOR NAME: ©W/tp K.- <br /> i� <br /> CONTRACTOR ADDRESS: - STREET <br /> CITY STATE ZIP <br /> CONTRACTOR,PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER ® ONTRACTOR ®.THER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ess o' <br /> , ,h C.,,, Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: as as I lklectric (a ther <br /> Building Type: PFR-DetachedF FR-Attached Igo uplex F ulti-Family-#of Units: le ommercial : ndustrial <br /> Type of Project: Fl ew IN'ddition = emoodel H•epair Fri .1. F'F.ign )x prinkler HDemolition hange of Use <br /> DESCRIPTION OF WORK: Flip / r-60P et,roop/{.e..$ i CJ <br /> . ..L-ns ,/l tieui e-44-1,e poo d 14 00 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> . u�MEcHAN#� L P.0f .I.xT. PLI AT ,, w 'F f1 <br /> �,.I���., {"�.. � � ��.�x� . .. ..,r �i� .I-qV MNI'N01PEP,MIT;A�yOfittGATIaMGr" r . <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> NC—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 /> I Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRIN'KLER,:I,SUPPRESS.IAN SYSTEM <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.I am the owner,or I am 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 of Everett Official Use Only <br /> c:&)e ,„/" ./4"i., f / 7 PERMIT#C. 17103 <br />