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PERMIT APPLIC.ATI—I <br /> ABUILDNU/MECHANICAL/PLUMBING/SIGN PRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,-z ,rL_ %':i 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 426-257-88671(E)everetfeps©everettwa.gav j www,evereftwa.govlpermits <br /> 0BJ oil; r• ( as*it O Iy Pgesse) . i:.ROJ TI`:i Cit Ii1Ml f�Jt� 'T1(0 • • . <br /> PROJECT SITE ADDRESS: j � f . PROPERTY TAX#: <br /> LEGAL for new cons#ruct on: Shod PIatfsubdlVisian Lot Nc. (attach qapy of long legal description) <br /> OWNER NAME: AA Tl1,f}A J l i,/trOPl 4it TENANT NAME(3f Commercial): <br /> OWNER MAILING ADDRESS: STREET -52.04V.161144-CaCL".r ,CL ).&~' <br /> CITY 1:5-74.1 STATE � P' L ZIP 4 a✓ <br /> OWNER PHONE (I/26-) . ` :...... .., OWNER EMAiLs <br /> CONTRACTOR NAME: C=t l v Mfid <br /> d <br /> CONTRACTOR ADDRESS: smear al zo PA--(14:(...e.... <br /> COY .-" .. STATE LOA Zip t1 V 24 t <br /> CONTRACTOR PHONE: 5425.E "Z%52.-- 51(1 CONTRACTOR EMAIL: 1.2.&44...61....e.-3.5 Wi(4,ie,,co Ai <br /> CONTRACTOR LICENSE#(REQUIRED): �"iI 2.egse en-- • CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O j Yy <br /> -,.w..+,.w»... ,..•.,rte, . N.r....�W..,...x. ,.....,e.�r •+:.e ..®«.......�....,.,...... -x.........«, •.«....«...N..e...,-w€...-:,.x.. «�...._ ..«t,�Fti,.•..q...,w�.i:..+,. .TM' <br /> PRIMARY CONTACT: CQ OWNER %CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( .$) 5-015 e 7`1z_ <br /> 1Le,t\a t CONTACT EMAIL: -+A-4 a 65 Y1l. -•67 <br /> ' ' .' • .. -stiff .D:iNQ PtitiotE'APPLIC TION 4. . .. . <br /> Existing Use of Building: Contract Price of Work:$ 91„006, --- <br /> - Proposed Use of Building: Heat Source: 64Gas DElectric ['Other <br /> Building Type: R.Detached OSFR Attached DDuplex DMulti-FemiIya#of Units: ❑Commercial ❑industrial• <br /> Type of Project: CI New ElAddifion )Remodel Repair 0T.1. ❑Sign ❑Sprinkler IIDemolition DChange of Use • <br /> DESCRIPTION OF WORK: OA rh+JGae GG. -7"- t ►.. ce"ivi i g79c, -iv/H04-1-t~ p <br /> • <br /> ASSOCIATED BUILDING PERMIT# If applicable): <br /> ,- -.. .110140111P44IPI p11,V4P) :II AT 0:#4 ': 1 p * 'N Ogiffir `0.0.1% ►' �0 .:. ' • ;1* <br /> Type of Project _New Addn ,iteration _.._„Repair ; Type of Project: New Addn _.Alteration „__Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC-Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg) . <br /> i Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor brain <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 /> . . Number of Heads <br /> ACKNOWLEDGEMENT•I have reviewed this application and confirm the information contained herein is tme 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 Offrclef before being authorized under any circumstance.I am the owner;or t 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 296200A WAC. <br /> gt___,. <br /> City of Everett Official Use Only <br /> PERIVIIT#�/�n 1� ` 0�1 <br /> Owner/A horized Agent Signature Date (Ravised 5120120i6) <br />