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Sep. 19. 2017 8: 37AM EVERGREEN STATE HEAT & AC No. 0294 P. 1/2 <br /> PERMIT APPLICATION <br /> jew <br /> BUILDING I MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION • <br /> CI1 YOF EVERETT PERMIT SERVICES <br /> Niii <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)Q5-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I pmw.everellwa.gov/permlls <br /> (itilyie'or)3lw k ink brim Pfease .-__ PRQJEIcI'SITE INF®RMATION --- _ <br /> PROJECT SITE ADDRESS: SU WIiji „) PROPERTY TAX#: (9OWI(6Wel 66A) <br /> LEGAL for new construcllon: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _ . ,copiritGY:INi*DR TION _ _ . -. . • . . . . .. <br /> OWNER NAME: 573 Gil(00/1) (.,(X• TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srmeer t9( 'f 041 r r <br /> _ c rT (0639./}"7- aura "IA zip ISM% <br /> OWNER PHONE: 'OWNER EMAIL: <br /> CONTRACTOR NAME: E J/f PA Ov 714-11C r {E6T?'{ 1-A'C- <br /> CONTRACTORADDRESS: STREET 2--1C)2.- RGI �V 0" . <br /> II CM( 0t �i r STATE ,(A.' -- Zia, clt�2(J/ <br /> 4 <br /> CONTRACTOR PHONE; 'Z5 -52--' J l4 • CONTRACTOR EMAIL: _444111;C ?4/4 -eekti <br /> CONTRACTOR LICENSE#(32EQUIRED): Eati512L•SS m22A,�. r- CITY OF EVERETT HusiNEss LICENSE#(REQUIRED): la p .__.. - <br /> PRIMARY CONTACT: ci OWNER 2.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 2 S-2-5-2--5//9 <br /> Mitt* 1 CONTACT EMAIL: mAteit.e.comu,,, - <br /> ., . , • ',!/ • BUILDING PERMIT AFP5N.ICAT[O - '. . • _ . _ <br /> Existing Use of Building: ,NO ! 6100" i Contract Price of Work:$ /4.1000 _ <br /> Proposed Use of Building: iN D Otaxl(p ti Heat Source: ❑Gas lifEleclric ElOther <br /> Building Type: IASFR Detached ❑SFR-Attached UDuptex ClMulti-Famliy#of Units: CUCommercial ❑industrial <br /> Type of Project: CINew cAddltion E lRemodei ElRepalr CT-l. C7SIgn EiSprtnkier ❑Demolltion riChan9e of use <br /> DESCRIPTION OF WORK: Relive/ £tet'CelC a tt44-ed Pio(a.,er (U F//Gg It 1, 1740T Acyl . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): - _, -,_ <br /> .1 " .1MflE'CiiAN(CAL PERIV ITAPPL'It ATION . • • Typ.of PLUEING EltfillT APPLICATION • <br /> Type of Project: New Addn1lterat[on Repair a of pro] MPecl: New y ddn Alteration Repair air <br /> #of List of Fixtures #of List of Fixtures #of list of Fixtures ti°P List of Fixtures <br /> Fixtures _ Fixtures Rxlures Fixtures <br /> A/C—Air Handling Units / Heat Pump Toilet Bactiflow Preventer Inside MktForced Alr Systems _ Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater - Refrigeration Shower -,, Floor Drain <br /> Gas Fire dark 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 - ,_ SInkSService/Bar/Mop/eto.) Other: <br /> .- F14iNpL1 1./,§,ii.iPPiIf m©Ti1 uySTEiw9 <br /> 'Number of Heads <br /> ACKNowLEDGEMENT°1 have reviewed this application end confirm the Information contained herein!stare and correct.Work done pursuant to this permit must comply with <br /> current federal,etete,and fors!taw.The granting of a permit only authorizes approved Work and no deviations therefrom.Deviations must dist be suthoitzed in wilting from the <br /> Building official before being authorized under any circumstance,i am the owner,or!am authorized by the owner of this property fa perform the work for which application Is made, <br /> and 1 comply with the State Contractors Law 1827 RDW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> '1,�c 'i/i guu7 PERMR\ _ o S 2 <br /> �svrtsr/Authoriz gent Signature Date (Revised a/20/2018) <br />