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• <br /> PERMIT APPLICATIOhr <br /> /11/%/41116/,----ABUILDINt CHANICAL I PLUMBING I SIGN ii INKLER I 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)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT:.SITE INFORMATION <br /> PROJECT SITE ADDRESS:31,7 PROPERTY TAX#: <br /> ISrauofwocy APO-2$OSU g0UZ0i-1700 <br /> I.EGAL for new construction: Short Plat/subdivision S S' 12.—0 03 Lot No. 2 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Adair L L C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (S CI Z Z 01E4 5 l bet, ,of f i V.. <br /> crrY LYylyl LvDi& STATE W R ZIP ge°2(7 <br /> OWNER PHONE: t/ - /t(3'I /7 t OWNER EMAIL: ( e,yr/ fl(Ir[f.f.. @ C,IMS;\ •L oywt <br /> CONTRACTOR NAME: ${Glitii- Fy {yµySfG( 1. L C <br /> CONTRACTOR ADDRESS: STREET /1 61 Z L 411 5 t ar c. <br /> Crr' Sr r:' f STATE V=4 ZIP <br /> CONTRACTOR PHONE: L/2 S'-7L./3- ) '7 I$ CONTRACTOR EMAIL: 0,dt(if-ewL-trpri is 9 e kvM:I. <br /> CONTRACTOR LICENSE#(REQUIRED): t)At R G L 63 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):03 6 Z./S' <br /> PRIMARY CONTACT: 2110VVNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:LI tt t CONTACT PHONE: ?!..; M IL/ - l d <br /> CONTACT EMAIL: ,golA;irct it-tlptiSCt, g90 "ti 'I•yt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 2_00,OOD <br /> Proposed Use of Building: 5 F R Heat Source: larGas ❑Electric ❑Other <br /> Building Type: Lilt'FR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: Mew ❑Addition ❑Remodel ❑Repair ❑T.I. El Sign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 'ew SF 11`- 5 i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION:, <br /> Type of Project: , New _ Addn _Alteration Repair Type of Project: 4New Addn _Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures_ Fixtures List of Fixtures Fixtures List of Fixtures <br /> p A/C—Air Handling Units Heat Pump 's Toilet tj Backflow Preventer(Inside Bldg) <br /> Forced Air Systems p Unit Heater 2, Bathtub 0 Urinal <br /> t. Gas Piping p Boiler 1-1 Lavatory(Wash Basin) ti Drinking Fountain <br /> ) Water Heater Refrigeration I Shower 0 Floor Drain <br /> [ Gas Fireplace p Wood Stove I Kitchen Sink&Disposal 0 Grease Trap <br /> I Gas Range 10 Ducting 1 Dishwasher 6 Roof Drains <br /> [ Clothes Dryer Hookups Other: ( Clothes Washer 0 Medical Gas <br /> I Range Hood I Water Heater Other: <br /> Li Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSIONSYSTEM <br /> 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,slate,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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ! City/of Everett Official Use Only <br /> � =►/' "L l�.r..�l�-� <br /> /-11 1/` 16 PERMIT# C 1 iU i - 013 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />