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01/10/2018 14 : 38 #3091 P. 001/002 <br /> PERMIT APPLICATION <br /> ---- BUILDING/MECHANICAL/PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> rte,` 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 .evereltwa.gov/permits <br /> Blue otr JIac k'•!clic•Ont•.Please . PRO:IRCT::SITIE 1INFORMATIOM • . •_ . •• • <br /> PROJECT SITE ADDRESS: f og< kuria r We. PROPERTY TAX#: <br /> LEGAL for new construction: Short Platrsubdivision Lot_.......1:4t...... ......,.................,...........— (attach copy of tong legal descnptlon) <br /> • • <br /> . _.:'.:': C!ON'-'1'AG1�1�fIrQ�RMATIpN:' :, <br /> OWNER NAME:SthiZ°AI /PJ/( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smesr /00S K� U C V� _ r <br /> _ �� STATE lei IJP <br /> +� CITY � —�—e <br /> OWNER PHONE: ' .. OWNER EMAIL: <br /> � <br /> CONTRACTOR NAME: i...4.__..4.__ ' A, i JI -. ' A t,i. ' <br /> CONTRACTOR ADDRESS: STREET 3(-GI 3 - ri .. ..d.,.Cm EVA-°rpIfO STATE �P ��6 1 <br /> CONTRACTOR PHONE _ _ • CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 0 _. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):t . , . <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) AO-- __ <br /> CONTACT NAME: CONTACT PHONE: y 2 / <br /> 4A CONTACT EMAIL: <br /> . •• ' . . • • • . • ..'••`BUILDING•.PERMITAPPLICAT1ON:.•.;• . `. • : • • .. <br /> Existing U Use of Building: —S'F fl- Contact Price of Work:s d <br /> Pro•.-ed Use of Buildint: Heat Source: Gari DElectric ClOther . <br /> Sui(din. T .e: QSFR-Detached ❑SFR-Attached 130u ilex 'COMulti-Famil 4 of Units: OCommercial Cllndustrial <br /> pe of Project ❑Now ClAddition ❑Remodel ❑Re•:ir DTA. ❑Sign ❑S•rinkler ❑Demolition OChan.aofUse <br /> DESCRIPTION OF WORK: <br /> R1 LAcc C M FL) /-C <br /> ASSOCIATED EUILDING PERMIT#(if aeplicable); <br /> , rip InumpowliMilliiiiMmIlIMOINMIP <br /> MECHANICAL•PERMIT APPLICATION.:` • • LUMEING:'PIRMIT'APPLICATION.•• <br /> Type of Project: New _ Addn !Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #or * List of Fbaurss e of List of Fixtures <br /> Ftawres <br /> List of Fixtures Fl au L 18t of Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toitet Backflow Preventer(Inside Bldg) <br /> _/ Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pi•in• Boiler Lavatory(Wash Basin) Drinking Fountain <br /> _ Water Heater Refrigeration Shower Floor Drain _ <br /> Gas Fireplace Wood Stove Kitchen Sink&Dia—,:1 Grease Tra• <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 /> SPR ISI:RR'/:SUPPRIEORION SYSTEM: <br /> 41•11 " [Chemical or Water I _____INo.of Heads1. <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 /> argent 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 circumatanco lam the owner,or/ant authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with = =le dors Law 78.29 RCW and 296.200A WAC. <br /> City of Everett Official L sa Only <br /> PERMIT# <br /> o . iautnortxed Ag t Signature Da (Revised 9/2312016) <br />